VISCERAL FAT AS A KEY DRIVER OF LIVER FIBROSIS IN MASLD: A DXA-BASED ANALYSIS

Introduction and Objectives

Adiposity is associated with an increased risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD).

Verify the association between liver fibrosis and visceral adiposity in MASLD by Dual-energy X-ray absorptiometry (DXA) method.

Materials and Methods

In a cross-sectional study, assessment of MASLD and significant fibrosis (F≥2) were performed by ultrassonography and transient elastography, respectively. Dual-energy X-ray absorptiometry (DXA) were performed to assess fat mass index (FMI), visceral adipose tissue (VAT)and android-to-gynoid (A/G) ratio. Data are reported as median (IQR) or n (%); p < 0.05 was considered significant

Results

141 participants were enrolled, 32(22.7%) had hepatic fibrosis. Age was 62.0(55.0–68.0) years, and 118(83.7%) were women. Adiposity parameters were waist-to-height ratio (WHtR) 0.66 (0.59–0.71); abdominal circumference (AC) 105.0(94.4–114.1) cm; fat mass index (FMI) 13.94 (10.50–17.20) kg/m²; VAT 1784 (1203–2430) cm³; and A/G 1.13 (1.04–1.23). The prevalence of obesity (BMI ≥ 30 kg/m²), high FMI (> 14 kg/m²), and A/G > 1 was 45(31.9%), 52(36.9%), and 130(92.2%) respectively. The groups with and without fibrosis were compared. Age and sex were similar between groups. Those with fibrosis had significantly higher WHtR, AC, VAT, trunk fat mass, android fat mass, and total fat mass. (Table 1).

Conclusions

This study shows that central and visceral adiposity are significantly linked to liver fibrosis. These findings are measured by DXA, an accurate method, and are supported by simple and cost-effective clinical measures such as WHtR and AC.

Conflict of interest: None

Table1. Clinical and body composition characteristics

Variable	General Population n = 141	Without Fibrosis n = 109	With Fibrosis n = 32	p-value
Age	62.0 (55.0–68.0)	62.0 (55.0–67.0)	65.0 (57.0–70.0)	0.063
Abdominal Circumference	105.0 (94.4–114.1)	103.0 (93.5–113.5)	110.15 (101.7–118.25)	0.029
Waist-to-Height Ratio (WHtR)	0.7 (0.6–0.7)	0.65 (0.59–0.71)	0.69 (0.64–0.75)	0.029
Arm Fat Mass (kg)	3.4 (2.7–4.5)	3.27 (2.49–4.44)	4.0 (3.19–4.75)	0.072
Leg Fat Mass (kg)	9.3 (7.1–12.8)	9.24 (6.41–12.82)	9.65 (8.22–12.60)	0.269
Trunk Fat Mass (kg)	19.2 (14.5–24.3)	18.47 (14.33–23.09)	22.76 (18.88–26.35)	0.020
Fat Mass Ratio (Trunk-to-Leg Fat Mass)	1.2 (1.1–1.4)	1.2 (1.07–1.35)	1.27 (1.07–1.38)	0.806
Android Fat Mass (kg)	3.3 (2.5–4.4)	3.2 (2.4–4.1)	3.84 (3.05–4.67)	0.047
Gynoid Fat Mass (kg)	5.2 (3.8–6.3)	4.85 (3.49–6.35)	5.46 (4.66–6.44)	0.102
Total Fat Mass (kg)	33.5 (25.8–42.0)	32.46 (24.51–41.06)	37.81 (30.91–45.66)	0.043
Android-to-Gynoid Fat Ratio (A/G Ratio)	1.1 (1.0–1.2)	1.13 (1.04–1.24)	1.13 (1.04–1.22)	0.681
Fat Mass Index (FMI) (kg/m^2)	13.9 (10.5–17.2)	13.78 (9.82–16.84)	15.1 (12.73–17.86)	0.104
Visceral Adipose Tissue Volume (cm^3)	1784.0 (1203.0–2430.0)	1504.0 (1171.0–2364.0)	2055.5 (1570.0–2598.25)	0.026
Visceral Adipose Tissue Mass (g)	1683.0 (1135.0–2292.0)	1419.0 (1068.0–2231.0)	1939.0 (1488.75–2451.75)	0.025

Legend: Values are presented as median (interquartile range). Bold p-values indicate statistical significance (p < 0.05).