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Association between metabolically healthy obesity and non-alcoholic fatty liver disease

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Abstract

Background

The risks of NAFLD and NAFLD with fibrosis progression among metabolically healthy obesity (MHO) individuals are largely unexplored. This cohort study investigated the association between MHO as well as other metabolic syndrome–obesity combined phenotypes and NAFLD and its fibrosis progression.

Methods

Participants included 31,010 adults from a health check-up cohort free from NAFLD and intermediate or high probability of advanced fibrosis at baseline. Metabolically healthy was defined as not having any component of metabolic syndrome. Obesity was identified by body mass index (BMI) and waist circumference (WC). Participants were cross-classified by metabolic health and obesity at baseline. The outcomes were NAFLD, and NAFLD with fibrosis progression, as assessed by abdominal B-type ultrasound and noninvasive fibrosis score.

Results

During a median follow-up of 2.2 (interquartile range, 1.2–4.9) years, 7,393 participants developed NAFLD. MHO individuals (HR 5.51, 95% CI 4.98, 6.09 for BMI criteria; HR 6.76, 95% CI 6.04, 7.57 for WC criteria) had a significantly higher risk of NAFLD than those with metabolically healthy normal weight or low WC. The corresponding HRs (95% CIs) for metabolically healthy overweight (defined by BMI) and medium WC were 2.74 (2.49–3.02) and 2.93 (2.65–3.24), respectively. Furthermore, 557 participants developed NAFLD with fibrosis progression. The association between different obesity phenotypes and NAFLD with fibrosis progression also showed a similar pattern.

Conclusion

MHO was associated with significantly higher risks of NAFLD and its fibrosis progression, suggesting that regarding NAFLD prevention, MHO individuals might still benefit from lifestyle interventions aimed at body weight and WC maintenance.

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Funding

This work was funded by the Ministry of Science and Technology of the People’s Republic of China (Grant number 2020YFC2003400); the National Natural Science Foundation of China (Grant number 91846303); and the Ministry of Science and Technology of the People’s Republic of China (Grant number 2020YFC2004703).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

    Sailimai Man, Jun Lv, Canqing Yu & Liming Li

  2. Meinian Institute of Health, Beijing, China

    Sailimai Man, Yuhan Deng & Bo Wang

  3. Peking University Health Science Center Meinian Public Health Institute, Beijing, China

    Sailimai Man, Jun Lv, Canqing Yu, Bo Wang & Liming Li

  4. Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China

    Jun Lv, Canqing Yu & Liming Li

  5. Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China

    Yuhan Deng

  6. MJ Health Care Group, Shanghai, China

    Jianchun Yin

  7. Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Hui Liu

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  1. Sailimai Man
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  2. Jun Lv
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  7. Liming Li
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Contributions

Conceptualization: SM, HL, BW, LL; Formal analysis: SM; Writing—original draft: SM, BW; Writing—review and editing: JL, CY, YD, HL, BW, LL; Data curation: JY; Funding acquisition: BW, LL; Resources: HL, BW, LL.

Corresponding authors

Correspondence to Bo Wang, Liming Li or Hui Liu.

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Conflict of interest

Sailimai Man, Jun Lv, Canqing Yu, Yuhan Deng, Jianchun Yin, Bo Wang, Hui Liu, and Liming Li declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Peking University Health Science Center (approval ID: IRB00001052-19077) and has, therefore, been performed in accordance with ethical standards and with the Helsinki Declaration of 1975, as revised in 1983. The requirement for informed consent of participants was waived, as we used only deidentified data obtained as part of routine health check-ups.

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Man, S., Lv, J., Yu, C. et al. Association between metabolically healthy obesity and non-alcoholic fatty liver disease. Hepatol Int 16, 1412–1423 (2022). https://doi.org/10.1007/s12072-022-10395-8

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  • DOI: https://doi.org/10.1007/s12072-022-10395-8

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