International journal of obesity (2005) · 2026
Adopting the lancet commission definition of clinical obesity in metabolic dysfunction-associated steatotic liver disease (MASLD).
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Ho Karen Cheuk-Ying, Hui Rex Wan-Hin, Wu Trevor Kwan-Hung, Lee Chi-Ho, Lui David Tak-Wai, Yuen Man-Fung, Seto Wai-Kay, Mak Lung-Yi
Аннотация
BACKGROUND: The Lancet Diabetes & Endocrinology Commission proposed a new definition of clinical obesity. We applied clinical obesity in a cohort of Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD) to evaluate its associations with clinical outcomes.
METHODS: We enrolled 642 MASLD patients with vibration-controlled transient elastography (VCTE) assessment. A subgroup of 254 patients underwent additional bioelectrical impedance analysis (BIA). The diagnosis of clinical obesity required fulfilment of both anthropometric and clinical criteria. At-risk metabolic dysfunction-associated steatohepatitis (MASH) was defined by FibroScan-AST (FAST) score. Major adverse cardiovascular events (MACE) were defined as a composite outcome of acute coronary syndrome or stroke.
RESULTS: Among 642 MASLD patients (mean age 55.8 ± 12.5 years; 49.2% male, mean BMI 28.2 ± 4.7 kg/m2, 76% severe steatosis, 12.5% advanced fibrosis/cirrhosis [F3/F4]), 46.1% of patients fulfilled the diagnosis of clinical obesity. Clinical obesity criteria identified more patients with F3/F4 (20.6% vs 8.1%, p < 0.001), severe steatosis (83.8% vs 67.6%, p < 0.001), at-risk MASH (3.4% vs 0%, p = 0.056) and MACE (11.2% vs 2.7%, p = 0.006) compared with BMI-based criteria. Clinical obesity was an independent predictor of F3/F4 (OR 4.074, 95% CI 2.195-7.563, p < 0.001) and severe steatosis (OR 2.441, 95% CI 1.638-3.637, p < 0.001). Among patients with BIA, clinical obesity was associated with a lower appendicular skeletal muscle mass (27.0% vs 41.1%, P < 0.001) and a greater visceral fat index (15 vs 9, p < 0.001) compared with BMI-based criteria.
CONCLUSION: Clinical obesity criteria identified more MASLD patients with F3/F4, severe steatosis, at-risk MASH and MACE compared with BMI-based obesity criteria. It should be regularly utilized for prognostication in MASLD evaluation.
METHODS: We enrolled 642 MASLD patients with vibration-controlled transient elastography (VCTE) assessment. A subgroup of 254 patients underwent additional bioelectrical impedance analysis (BIA). The diagnosis of clinical obesity required fulfilment of both anthropometric and clinical criteria. At-risk metabolic dysfunction-associated steatohepatitis (MASH) was defined by FibroScan-AST (FAST) score. Major adverse cardiovascular events (MACE) were defined as a composite outcome of acute coronary syndrome or stroke.
RESULTS: Among 642 MASLD patients (mean age 55.8 ± 12.5 years; 49.2% male, mean BMI 28.2 ± 4.7 kg/m2, 76% severe steatosis, 12.5% advanced fibrosis/cirrhosis [F3/F4]), 46.1% of patients fulfilled the diagnosis of clinical obesity. Clinical obesity criteria identified more patients with F3/F4 (20.6% vs 8.1%, p < 0.001), severe steatosis (83.8% vs 67.6%, p < 0.001), at-risk MASH (3.4% vs 0%, p = 0.056) and MACE (11.2% vs 2.7%, p = 0.006) compared with BMI-based criteria. Clinical obesity was an independent predictor of F3/F4 (OR 4.074, 95% CI 2.195-7.563, p < 0.001) and severe steatosis (OR 2.441, 95% CI 1.638-3.637, p < 0.001). Among patients with BIA, clinical obesity was associated with a lower appendicular skeletal muscle mass (27.0% vs 41.1%, P < 0.001) and a greater visceral fat index (15 vs 9, p < 0.001) compared with BMI-based criteria.
CONCLUSION: Clinical obesity criteria identified more MASLD patients with F3/F4, severe steatosis, at-risk MASH and MACE compared with BMI-based obesity criteria. It should be regularly utilized for prognostication in MASLD evaluation.