The development of liver fibrosis worsens the prognosis of patients with non-alcoholic fatty liver disease (NAFLD) but very less is known about the risk factors for the progression of NAFLD to liver fibrosis. 

A cross-sectional study examined the association of liver fibrosis with metabolically healthy and unhealthy obesity among patients with NAFLD.

Ultrasonography was used to assess the severity of fatty liver and a NAFLD fibrosis score was used to determine the severity of liver fibrosis. Along with it, Anthropometric indices, physical activity, and body composition were also evaluated. Serum metabolic parameters were determined in blood samples. 

Metabolically healthy Participants were described as those without any component of metabolic syndrome and homeostasis model assessment of insulin resistance (HOMA-IR) <2.5. 

The following observations were made-

• 246 patients with NAFLD and a low probability of fibrosis were enrolled in the study. 
• 3% of subjects were found to be metabolically healthy while 53.7% were found metabolically unhealthy. 
• Multivariable‐adjusted ORs (CIs) for worsening of NAFLD fibrosis score comparing body mass indexes (BMIs) 23.0–24.9, 25–29.9, and ≥30 with a BMI=18.5–22.9 kg/m2 were 1.28, 1.99, and 3.96, respectively, in metabolically healthy subjects.
• While it was 1.39, 2.27, and 4.11, respectively, in metabolically unhealthy subjects. 
• Both healthy and unhealthy individuals demonstrated worsening of NAFLD fibrosis score with higher percentages of body fat and waist circumference.

Thus it was concluded that excess body fat worsens liver fibrosis regardless of metabolic health status.

Source- Clinics and Research in Hepatology and Gastroenterology,2021;45(6). https://doi.org/10.1016/j.clinre.2021.101754.