BMJ open · 2026
Body weight categories and fat distribution in relation to all-cause mortality among adults with metabolic dysfunction-associated steatotic liver disease: a population-based analysis of NHANES, 2007-2018.
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Kueh Martin Tze Wah, Intaran Made Ayu Utami, Goh Rachel, Kong Gwyneth, Koh Hui Lian, Chin Yip Han, Chan Mark Y, Le Roux Carel W, Mehta Anurag, Khan Muhammad Shahzeb, Muthiah Mark D, Chew Nicholas Ws
Аннотация
OBJECTIVE: Although body mass index (BMI)-defined non-obesity metabolic dysfunction-associated steatotic liver disease (MASLD) predicts poor prognosis, the role of visceral adiposity and weight-based phenotypes is unclear. This study aimed to examine the clinical correlates of four unique MASLD phenotypes based on BMI and waist-to-height ratio (WHtR) and to assess the prognostic value of this classification with respect to mortality.
DESIGN: Population-based cross-sectional study with prospective mortality follow-up.
SETTING: Nationally representative US population derived from the National Health and Nutrition Examination Survey (NHANES), 2007-2018.
PARTICIPANTS: 6300 adults with MASLD, sampled from NHANES 2007 to 2018.
METHODS: Participants were allocated into four phenotypes based on obesity/lean and central adiposity status. Obesity was defined as BMI≥30 kg/m², while those without obesity were determined as lean. High central adiposity was defined as WHtR≥0.6.
PRIMARY OUTCOME MEASURE: The primary outcome was all-cause mortality. This was ascertained through National Death Index linkage with follow-up censored at 31 December 2019.
RESULTS: Among adults with MASLD, 72.1% had obesity with high central adiposity (mean follow-up: 6.9±3.5 years). The non-obesity, high central adiposity phenotype (9.6%) exhibited the highest rates of hypertension (60.2%), type 2 diabetes (31.8%) and chronic kidney disease (23.3%). This phenotype portended the poorest 6-year survival (p<0.001) and was independently associated with higher all-cause mortality (adjusted HR (aHR) 3.1, 95% CI 1.3 to 7.7). A J-shaped association was observed between BMI and mortality, with increasing WHtR linked to elevated risk.
CONCLUSION: Non-obesity MASLD with high central adiposity confers the poorest survival and cardiometabolic burden.
DESIGN: Population-based cross-sectional study with prospective mortality follow-up.
SETTING: Nationally representative US population derived from the National Health and Nutrition Examination Survey (NHANES), 2007-2018.
PARTICIPANTS: 6300 adults with MASLD, sampled from NHANES 2007 to 2018.
METHODS: Participants were allocated into four phenotypes based on obesity/lean and central adiposity status. Obesity was defined as BMI≥30 kg/m², while those without obesity were determined as lean. High central adiposity was defined as WHtR≥0.6.
PRIMARY OUTCOME MEASURE: The primary outcome was all-cause mortality. This was ascertained through National Death Index linkage with follow-up censored at 31 December 2019.
RESULTS: Among adults with MASLD, 72.1% had obesity with high central adiposity (mean follow-up: 6.9±3.5 years). The non-obesity, high central adiposity phenotype (9.6%) exhibited the highest rates of hypertension (60.2%), type 2 diabetes (31.8%) and chronic kidney disease (23.3%). This phenotype portended the poorest 6-year survival (p<0.001) and was independently associated with higher all-cause mortality (adjusted HR (aHR) 3.1, 95% CI 1.3 to 7.7). A J-shaped association was observed between BMI and mortality, with increasing WHtR linked to elevated risk.
CONCLUSION: Non-obesity MASLD with high central adiposity confers the poorest survival and cardiometabolic burden.