Obesity and Risk of Nonalcoholic Fatty Liver Disease: A Comparison of Bioelectrical Impedance Analysis and Conventionally-Derived Anthropometric Measures

Regional fat distribution and hepatic fibrosis and steatosis severity in patients with nonalcoholic fatty liver disease and type 2 diabetes

Background

Epidemiologic findings suggest that measures of body fat distribution predict health outcomes independent of the overall body fat assessed by body mass index (BMI). This study aimed to evaluate the associations of overall and regional body fat with the severity of hepatic steatosis and fibrosis in type 2 diabetic patients with non-alcoholic fatty liver disease.

Methods

Bioelectric impedance analysis and two newly developed anthropometric indices, namely, A Body Shape Index (ABSI) and Body Roundness Index (BRI), were used to estimate the body fat. Based on fibroscan parameters, significant hepatic fibrosis and severe steatosis were defined as ≥F2 and >66%, respectively.

Results

Higher total body fat (odds ratio [OR] 1.107, 95% confidence intervals (CI) 1.038-1.182, p = 0.002), trunk fat (OR 1.136, 95% CI 1.034-1.248, p = 0.008) and leg fat (OR 1.381, 95% CI 1.139-1.674, p = 0.001) were associated with liver fibrosis. However, in contrast to the total body fat (OR 1.088, 95% CI 1.017-1.164, p = 0.014) and leg fat (OR 1.317, 95% CI 1.066-1.628, p = 0.011), the trunk fat was not associated with severe hepatic steatosis. BRI performed better than trunk, leg and total body fat in predicting hepatic steatosis (OR 2.186, 95% CI 1.370-3.487, p = 0.001) and fibrosis (OR 2.132, 95% CI 1.419-3.204, p < 0.001). Moreover, the trunk to leg fat ratio and ABSI were not independent predictors of either steatosis or fibrosis (p > 0.05).

Conclusion

BRI revealed a superior predictive ability for identifying the degree of hepatic steatosis and stiffness than other obesity indices. Additionally, higher levels of adiposity in the trunk, legs, and overall body were linked to an increased risk of developing liver fibrosis. Although trunk fat did not show an association with severe hepatic steatosis, an increase in leg and total fat was related to liver steatosis.

Effect of weight satisfaction on adolescent facial and dental satisfaction

PURPOSE

To investigate if facial and dental satisfaction is related to body fat percentage and body weight satisfaction.

METHODS

A self-administered questionnaire was applied to adolescents from a Private School in Southern Brazil containing sociodemographic (sex and age) and self-perception variables. Adolescents were asked about their perceptions concerning dental problems. Body fat percentage was collected using bioelectrical impedance analysis.

RESULTS

A total of 372 adolescents were examined. Most adolescents were satisfied with their dental (81.7%) and facial appearance (87.6%), while 39% of adolescents were satisfied with their body weight. Poisson regression model showed that adolescents who expressed satisfaction with their body weight (PR = 1.12, 95%CI 1.06-1.19) and were satisfied with their dental appearance (PR = 1.24, 95% CI 1.08-1.41) exhibited a positive association with facial satisfaction. Adolescents dissatisfied with dental color (PR = 0.88, 95%CI 0.80-0.97), those reporting dental pain (PR = 0.88, 95%CI 0.80-0.97), and individuals with obesity (PR = 0.91, 95%CI 0.83-0.99) demonstrated a decrease in facial satisfaction. Adolescents aged 16 to 19 years (PR = 1.08, 95% CI 1.01-1.15) and those satisfied with their facial appearance (PR = 1.20, 95%CI 1.01-1.43) exhibited a higher prevalence of dental satisfaction. Conversely, adolescents dissatisfied with dental color (PR = 0.74, 95% CI 0.66-0.82) and those with misaligned teeth (PR = 0.63, 95%CI 0.55-0.73) reported lower levels of dental satisfaction. Parametric g-formula analysis found that the association between body fat and facial satisfaction was mediated by body weight satisfaction (p = 0.001).

CONCLUSIONS

While dental satisfaction was not influenced by corporeal characteristics, facial satisfaction was influenced by dental and body weight satisfaction. Obese adolescents had low facial satisfaction.

Association between TyG index trajectory and new-onset lean NAFLD: a longitudinal study

OBJECTIVE

The purpose of this manuscript is to identify longitudinal trajectories of changes in triglyceride glucose (TyG) index and investigate the association of TyG index trajectories with risk of lean nonalcoholic fatty liver disease (NAFLD).

METHODS

Using data from 1,109 participants in the Health Management Cohort longitudinal study, we used Latent Class Growth Modeling (LCGM) to develop TyG index trajectories. Using a Cox proportional hazard model, the relationship between TyG index trajectories and incident lean NAFLD was analyzed. Restricted cubic splines (RCS) were used to visually display the dose-response association between TyG index and lean NAFLD. We also deployed machine learning (ML) via Light Gradient Boosting Machine (LightGBM) to predict lean NAFLD, validated by receiver operating characteristic curves (ROCs). The LightGBM model was used to create an online tool for medical use. In addition, NAFLD was assessed by abdominal ultrasound after excluding other liver fat causes.

RESULTS

The median age of the population was 46.6 years, and 440 (39.68%) of the participants were men. Three distinct TyG index trajectories were identified: "low stable" (TyG index ranged from 7.66 to 7.71, n=206, 18.5%), "moderate stable" (TyG index ranged from 8.11 to 8.15, n=542, 48.8%), and "high stable" (TyG index ranged from 8.61 to 8.67, n=363, 32.7%). Using a "low stable" trajectory as a reference, a "high stable" trajectory was associated with an increased risk of lean-NAFLD (HR: 2.668, 95% CI: 1.098-6.484). After adjusting for baseline age, WC, SBP, BMI, and ALT, HR increased slightly in "moderate stable" and "high stable" trajectories to 1.767 (95% CI:0.730-4.275) and 2.668 (95% CI:1.098-6.484), respectively. RCS analysis showed a significant nonlinear dose-response relationship between TyG index and lean NAFLD risk (χ2 = 11.5, P=0.003). The LightGBM model demonstrated high accuracy (Train AUC 0.870, Test AUC 0.766). An online tool based on our model was developed to assist clinicians in assessing lean NAFLD risk.

CONCLUSION

The TyG index serves as a promising noninvasive marker for lean NAFLD, with significant implications for clinical practice and public health policy.

Application of machine learning in predicting non-alcoholic fatty liver disease using anthropometric and body composition indices

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, which can progress from simple steatosis to advanced cirrhosis and hepatocellular carcinoma. Clinical diagnosis of NAFLD is crucial in the early stages of the disease. The main aim of this study was to apply machine learning (ML) methods to identify significant classifiers of NAFLD using body composition and anthropometric variables. A cross-sectional study was carried out among 513 individuals aged 13 years old or above in Iran. Anthropometric and body composition measurements were performed manually using body composition analyzer InBody 270. Hepatic steatosis and fibrosis were determined using a Fibroscan. ML methods including k-Nearest Neighbor (kNN), Support Vector Machine (SVM), Radial Basis Function (RBF) SVM, Gaussian Process (GP), Random Forest (RF), Neural Network (NN), Adaboost and Naïve Bayes were examined for model performance and to identify anthropometric and body composition predictors of fatty liver disease. RF generated the most accurate model for fatty liver (presence of any stage), steatosis stages and fibrosis stages with 82%, 52% and 57% accuracy, respectively. Abdomen circumference, waist circumference, chest circumference, trunk fat and body mass index were among the most important variables contributing to fatty liver disease. ML-based prediction of NAFLD using anthropometric and body composition data can assist clinicians in decision making. ML-based systems provide opportunities for NAFLD screening and early diagnosis, especially in population-level and remote areas.

Lipoprotein Levels in Early Adulthood and NAFLD in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Objective

We evaluated the association of apolipoprotein B (apoB) with low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG) in early adulthood with concordant/discordant associations and midlife NAFLD.

Methods

Participants from the CARDIA study were included (n = 2,655; baseline mean age: 25.0, 59.1% female, and 48.6% black). NAFLD was defined as liver attenuation ≤40 Hounsfield units after excluding other causes of liver fat. Logistic regression models assessed the odds of Y25 NAFLD among tertiles of apoB, LDL-C, non-HDL-C, and TG and quartiles of the apoB/TG ratio. Discordance/concordance analyses examined the association of apoB with each lipid marker and Y25 NAFLD.

Results

The Y25 NAFLD prevalence was 10%. The high-tertile TG group (OR 1.87, 95% CI, and 1.30–2.69) and the low- (OR 1.98, 95% CI, and 1.30–3.01) and middle-apoB/TG ratio groups (OR 1.78, 95% CI, and 1.17–2.72) had the greatest odds of midlife NAFLD. Using discordance/concordance analysis, the high-apoB/high-TG group had the highest odds of NAFLD (OR 1.69, 95% CI, and 1.09–2.61) followed by the low-apoB/high-TG group. The high apoB/low TG group had the lowest odds of NAFLD.

Conclusions

Among the studied lipid markers in early adulthood, TG levels have the strongest and most consistent association with midlife NAFLD.

Comparison of bioelectrical impedance analysis, mass index, and waist circumference in assessing risk for non-alcoholic steatohepatitis

OBJECTIVE

Non-alcoholic fatty liver disease is a leading cause of liver disease worldwide and includes nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis. Because NASH is associated with obesity severity, routine evaluation of obesity/body fat in clinical settings may help detect patients at risk. The aim of this study was to determine whether assessing body fat by bioelectrical impedance analysis (BIA) is superior to body mass index (BMI) and waist circumference (WC) in assessing the risk for NASH.

METHODS

In this cross-sectional study, patients were recruited and gave consent from a local hospital. All had a liver biopsy. Measurements before the biopsy included BMI, WC, and BIA. BIA was used to measure percentage body fat and fat mass (kg). Based on histology, patients were grouped into one of three categories: simple steatosis (SS), NASH, or normal liver (NL).

RESULTS

Of the 139 participants who participated, 39 were classified as SS, 53 as NASH, and 47 as NL. Regardless of sex, patients with NASH had significantly higher BMI, WC, percentage body fat and fat mass than those with NL or SS. These four parameters were significantly positively correlated with liver histology measurements. In all patients, when controlling for sex and age we found that BMI, WC, and BIA were equal at predicting the presence of NASH (P = 0.0571).

CONCLUSION

All three methods, BIA, BMI, and WC, were comparable in assessing the risk for NASH. For practical purpose in clinical settings, using BMI is acceptable.

Association of Body Composition and Sarcopenia with NASH in Obese Patients

Obese patients often suffer from sarcopenia or sarcopenic obesity (SO) that can trigger inflammatory diseases including non-alcoholic steatohepatitis (NASH). Sarcopenia and SO can be diagnosed through measuring parameters of body composition such as skeletal muscle mass (SMM), skeletal muscle index (SMI) and fat mass (FM) obtained by bioelectrical impedance analysis (BIA). The aim of this study was to assess the relationship of body composition and NASH in patients with obesity. A total of 138 patients with obesity that underwent bariatric surgery were included in this study. BIA was used to estimate body composition. A liver biopsy was taken intraoperatively and histological assessment of NASH was performed. A total of 23 patients (17%) were classified as NASH and 65 patients (47%) met the criteria for borderline NASH. Body mass index (BMI) was significantly higher in patients with NASH compared to borderline NASH and no NASH (56.3 kg/m² vs. 51.6 kg/m² vs. 48.6 kg/m², p = 0.004). Concerning body composition, FM, but also SMM and SMI were significantly higher in patients with NASH (p-values 0.011, 0.005 and 0.006, resp.). Fat mass index (FMI) and weight-adjusted skeletal muscle index (SMI_weight) failed to reach statistical significance (p-values 0.067 and 0.661). In patients with obesity, higher FM were associated with NASH. Contrary to expectations, SMM and SMI were also higher in patients with NASH. Therefore, higher body fat, rather than sarcopenia and SO, might be decisive for development of NASH in patients with obesity.

Rapid Onset of Weight Gain and Liver Dysfunction Successfully Treated With Nutrition and Exercise

Physical inactivity is one of the causes of most metabolic syndromes. The incidence of metabolic syndrome is expected to increase in the near future because of the reduced opportunities for exercise caused by COVID-19. Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease. Changes in diet and lifestyle have led to a dramatic increase in the prevalence of NAFLD in the world. NAFLD is characterized by excessive triglyceride (TG) accumulation in the hepatocytes due to both increased inflow of free fatty acids and de novo hepatic lipogenesis. Thus far, no study quantitatively assessed the liver fat deposition after a rapid decline in physical activity. Herein, we describe a case of a 17-year-old Japanese boy with severe fat infiltration of the liver, due to a rapid decline in physical activity, treated at our facility. Our rehabilitation and nutritional support teams administered appropriate exercise and nutrition support to reduce weight and improve liver dysfunction. Our findings support dietary changes and exercise therapy to manage such cases.

Nutritional status and energy metabolism in elderly patients with nonalcoholic fatty liver disease

BACKGROUND

With the aging of global population and the increase in the incidence of NAFLD, the research of elderly NAFLD population is particularly important.

AIM

To study the nutritional status and energy metabolism in elderly patients with nonalcoholic fatty liver disease (NAFLD) to provide evidence for disease evaluation, clinical monitoring, and treatment intervention.

METHODS

One hundred and eighteen elderly patients (≥ 60 years) with NAFLD were enrolled at Department of Gastroenterology Tianjin Third Central Hospital from January 2017 to January 2019. A non-NAFLD group consisting of non-NAFLD volunteers ≥ 60 years was also included. Nutritional status and energy metabolism were evaluated with a body composition analyzer and metabolic cart ( anthropometric measurement, clinical biochemical examination, etc.).

RESULTS

Body composition analysis showed that the waist-to-hip fat ratio and body fat content of the NAFLD group were significantly higher (waist-to-hip fat ratio 0.95 vs 0.92, body fat 27.20 vs 19.60 kg, P < 0.05) compared with those of the non-NAFLD group. The results of metabolic vehicle showed that the resting energy expenditure (REE) of the NAFLD group was increased (1769.00 vs 1706.00 vs 1323.00). In elderly NAFLD patients, body fat, waist-to-hip fat ratio, basal metabolism, and REE in the mild fatty liver group were significantly lower than those in the moderate-severe fatty liver group.

CONCLUSION

In elderly patients with NAFLD, there are nutritional imbalance and energy metabolism disorder. The nutritional status and energy metabolism of elderly NAFLD patients can be comprehensively evaluated and monitored with a body composition analyzer and metabolic vehicle, so as to provide evidence for disease intervention.

Associations between Phase Angle Values Obtained by Bioelectrical Impedance Analysis and Nonalcoholic Fatty Liver Disease in an Overweight Population

OBJECTIVE

There is a limited diagnosis of nonalcoholic fatty liver disease (NAFLD). Thus, the noninvasive assessments are worth exploring. We determined the associations of phase angles (PhAs) obtained from bioelectric impedance analysis (BIA) with the risk of NAFLD in an overweight population.

METHODS

A study involving 953 overweight participants was conducted in Wuhan city, China. The associations between PhAs (right arm, left arm, body trunk, right leg, left leg, and whole body) and the risk of NAFLD were conducted using multivariate logistic regression analyses. The associations of PhAs with the controlled attenuation parameter (CAP), a noninvasive assessment of liver steatosis and fibrosis, were also evaluated by both linear and logistic regression analyses.

RESULTS

The PhA values of the whole body, trunk, and legs were significantly lower (P < 0.05) in the NAFLD group than the non-NAFLD group. After adjustment for BMI, gender, education, income/year, hyperlipidemia, hypertension, diabetes, smoking, passive smoking, and drinking, significant associations of PhA values of the right leg, left leg, and whole body with the risk of NAFLD were observed. In addition, the PhA of the right leg, left leg, and whole body were significantly related to the CAP values. Further stratified analyses indicated that these associations were significant in the participants with BMI <30, but not in the participants with BMI ≥30.

CONCLUSIONS

PhAs might be effective indicators in the management of NAFLD among overweight people.

Burden of nonalcoholic fatty liver disease in Canada, 2019-2030: a modelling study

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) account for a growing proportion of liver disease cases, and there is a need to better understand future disease burden. We used a modelling framework to forecast the burden of disease of NAFLD and NASH for Canada.

METHODS

We used a Markov model to forecast fibrosis progression from stage F0 (no fibrosis) to stage F4 (compensated cirrhosis) and subsequent progression to decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death among Canadians with NAFLD from 2019 to 2030. We used historical trends for obesity prevalence among adults to estimate longitudinal changes in the number of incident NAFLD cases.

RESULTS

The model projected that the number of NAFLD cases would increase by 20% between 2019 and 2030, from an estimated 7 757 000 cases to 9 305 000 cases. Increases in advanced fibrosis cases were relatively greater, as the number of model-estimated prevalent stage F3 cases would increase by 65%, to 357 000, and that of prevalent stage F4 cases would increase by 95%, to 195 000. Estimated incident cases of hepatocellular carcinoma and decompensated cirrhosis would increase by up to 95%, and the number of annual NAFLD-related deaths would double, to 5600.

INTERPRETATION

Increasing rates of obesity translate into increasing NAFLD-related cases of cirrhosis and hepatocellular carcinoma and related mortality. Prevention efforts should be aimed at reducing the incidence of NAFLD and slowing fibrosis progression among those already affected.

Different levels of physical activity and anthropometric profile in patients infected with hepatitis C virus

Study aim: To verify the relationship between different durations of regular practice of physical activity in aspects related to the anthropometric profile and hepatic function of patients infected by hepatitis C virus (HCV). Material and methods: 125 patients (aged 55.2 ± 10.4 years) participated in the study. Clinical data were obtained through medical records available at the Pernambuco Liver Institute. Physical activity levels were obtained through the International Physical Activity Questionnaire (IPAQ) short form to classify the patients according to the guidelines of the American College of Sports Medicine (ACSM). Results: Significant differences were found in GGT 141 (28-378 U/L) and HDL 39 (27-56 mg/dL) respectively in insuffi­ciently active and physically active groups, AST 71 (26-268 U/L), ALT 83 (36-452 U/L), GGT 78 (3-532 U/L), alkaline phos­phatase 74 (47-302 mg/dL) and total bilirubin 0.7 (0.1-2.8 mg/dL) in insufficiently active and very physically active groups. Anthropometric data showed significant differences in chest (p < 0.01), abdomen (p < 0.02) and waist measurement (p < 0.01) between insufficiently active and very physically active groups.

Conclusion: Physical activity, when practiced regularly for more than 300 minutes per week, can improve the clinical and an­thropometric profile in patients infected with HCV.