A retrospective study of 2,091 patients with severe obesity found that commonly used anthropometric indices, including body mass index, waist circumference, and waist-to-hip ratio may not be significantly associated with the severity of metabolic dysfunction–associated fatty liver disease or metabolic dysfunction–associated steatohepatitis.
In the study, published in the Canadian Journal of Gastroenterology and Hepatology, investigators reported that metabolic dysfunction–associated fatty liver disease (MAFLD) was prevalent in 79.5% of participants; however, no adiposity indices reliably predicted its severity.
The investigators analyzed preoperative data from patients eligible for bariatric surgery, measuring anthropometric indices such as body mass index (BMI) (mean = 47.9 ± 7.3 kg/m²), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and neck circumference (NC). They found that 44.5% of the participants had metabolic dysfunction–associated steatohepatitis (MASH), and 24.4% of them had severe fibrosis (F2 to F4), yet statistical analyses did not establish consistent correlations between these indices and disease severity.
Although no anthropometric indices were strong predictors of MAFLD severity, the investigators identified sex as a significant factor. For instance, female patients with severe obesity had a higher risk of severe fibrosis (odds ratio = 1.27, 95% confidence interval = 1.01–1.59, P < .05). Despite being younger (mean age = 44 ± 10 years vs 48 ± 11 years) and having lower WC (132.5 ± 13.1 cm vs 144.8 ± 15.0 cm, P < .05), female patients exhibited similar or greater rates of liver fibrosis compared with male patients.
"Our results from this specific population do not show sex differences in the prevalence of MAFLD, MASH, and detrimental histopathologic features of MAFLD, including advanced stages of fibrosis," said lead study author Fannie Lajeunesse-Trempe, of the Department of Specialized Medicine, Internal Medicine at the Quebec Heart and Lung Institute at Laval University in Quebec, and colleagues.
The findings highlighted the limitations of anthropometric indices in assessing MAFLD progression among patients with severe obesity. Given the high prevalence and reversibility of MAFLD and MASH, more studies are needed to examine sex differences in MAFLD and incorporate direct measurements of visceral adipose tissue, subcutaneous adipose tissue, or other biological markers.
Full authors' disclosures are available in the study.