Individuals with two or more metabolic risk factors are at risk for hepatic steatosis and fibrosis, according to a study reported in Clinical Gastroenterology and Hepatology.¹

Researchers from the Harvard Medical School and Boston University School of Medicine examined data of participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES). Their objective was to investigate the role of different metabolic factors for steatosis and fibrosis. A total of 4369 adults, aged ≥18 (age range 43-54) years, were selected for the study; of these, 1234 had hepatic steatosis and 403 had fibrosis; the remaining 2732 were healthy. Pregnant women and those with a history of viral hepatitis were excluded. 

Seven cardiometabolic risk factors, as per the criteria used to define metabolic-associated fatty liver disease (MAFLD),² were studied: waist circumference, insulin resistance, blood pressure, prediabetes, inflammation (hs-CRP), plasma high-density lipoprotein (HDL) cholesterol, and plasma triglycerides. The cut-off for presence of steatosis was controlled attenuation parameter (CAP) ≥290 dB/m, and median liver stiffness measurement (LSM) ≥8.2 kPa was defined as fibrosis. The cut-offs for waist circumference were 102 cm/90 cm for non-Asian/Asian men, and 88 cm/80 cm for non-Asian/Asian women. The metabolic factors were linked with CAP and LSM cut-offs to establish their role in MAFLD using multivariable- and survey-adjusted regression models.

A large number of participants, ranging from 55%-92%, had a minimum of two metabolic risk factors. The prevalence of diabetes was 7%-40%.

The likelihood of steatosis and fibrosis was significantly higher among participants who had ≥2 metabolic risk factors, with adjusted odds ratio (aOR) of 5.8 for steatosis and 2.5 for hepatic fibrosis. This association was independent of high body mass index (BMI >23 Kg/m² for Asians and >25 Kg/m² for non-Asians) and diabetes status. Among the seven risk factors under study, insulin resistance (HOMA-IR ≥2.5) and central obesity had the maximum contributions to the increased risk of steatosis and fibrosis. The aOR for steatosis was 3.96 for insulin resistance and 2.8 for fibrosis. The aOR for steatosis was 5.98 for increased waist circumference and 4.43 for fibrosis.

This study identified waist circumference or central obesity and insulin resistance as two major risk factors for hepatic steatosis and subsequent fibrosis; this can serve as simple tools in screening for MAFLD and risk stratification of disease.

References

1. Claypool K, et al. Waist circumference and insulin resistance are the most predictive metabolic factors for steatosis and fibrosis. Clin Gastroenterol Hepatol. 2022 Jun 4:S1542-3565(22)00532-8. doi: 10.1016/j.cgh.2022.05.02.
2. Eslam M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol. 2020 Jul;73(1):202-209. doi: 10.1016/j.jhep.2020.03.039.