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Background <p>The Lancet Diabetes &amp; Endocrinology Commission proposed a new definition of clinical obesity. We applied clinical obesity in a cohort of Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD) to evaluate its associations with clinical outcomes.</p> Methods <p>We enrolled 642 MASLD patients with vibration-controlled transient elastography (VCTE) assessment. A subgroup of 254 patients underwent additional bioelectrical impedance analysis (BIA). The diagnosis of clinical obesity required fulfilment of both anthropometric and clinical criteria. At-risk metabolic dysfunction-associated steatohepatitis (MASH) was defined by FibroScan-AST (FAST) score. Major adverse cardiovascular events (MACE) were defined as a composite outcome of acute coronary syndrome or stroke.</p> Results <p>Among 642 MASLD patients (mean age 55.8 ± 12.5 years; 49.2% male, mean BMI 28.2 ± 4.7 kg/m<sup>2</sup>, 76% severe steatosis, 12.5% advanced fibrosis/cirrhosis [F3/F4]), 46.1% of patients fulfilled the diagnosis of clinical obesity. Clinical obesity criteria identified more patients with F3/F4 (20.6% vs 8.1%, <i>p</i> &lt; 0.001), severe steatosis (83.8% vs 67.6%, <i>p</i> &lt; 0.001), at-risk MASH (3.4% vs 0%, <i>p</i> = 0.056) and MACE (11.2% vs 2.7%, <i>p</i> = 0.006) compared with BMI-based criteria. Clinical obesity was an independent predictor of F3/F4 (OR 4.074, 95% CI 2.195–7.563, <i>p</i> &lt; 0.001) and severe steatosis (OR 2.441, 95% CI 1.638–3.637, <i>p</i> &lt; 0.001). Among patients with BIA, clinical obesity was associated with a lower appendicular skeletal muscle mass (27.0% vs 41.1%, <i>P</i> &lt; 0.001) and a greater visceral fat index (15 vs 9, <i>p</i> &lt; 0.001) compared with BMI-based criteria.</p> Conclusion <p>Clinical obesity criteria identified more MASLD patients with F3/F4, severe steatosis, at-risk MASH and MACE compared with BMI-based obesity criteria. It should be regularly utilized for prognostication in MASLD evaluation.</p>

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Adopting the lancet commission definition of clinical obesity in metabolic dysfunction-associated steatotic liver disease (MASLD)

  • 期刊论文

  • 发表日期：

    2026年7月17日

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  • Karen Cheuk-Ying Ho,
  • Rex Wan-Hin Hui,
  • Trevor Kwan-Hung Wu,
  • Chi-Ho Lee,
  • David Tak-Wai Lui,
  • Man-Fung Yuen,
  • Wai-Kay Seto,
  • Lung-Yi Mak

摘要

Background

The Lancet Diabetes & Endocrinology Commission proposed a new definition of clinical obesity. We applied clinical obesity in a cohort of Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD) to evaluate its associations with clinical outcomes.

Methods

We enrolled 642 MASLD patients with vibration-controlled transient elastography (VCTE) assessment. A subgroup of 254 patients underwent additional bioelectrical impedance analysis (BIA). The diagnosis of clinical obesity required fulfilment of both anthropometric and clinical criteria. At-risk metabolic dysfunction-associated steatohepatitis (MASH) was defined by FibroScan-AST (FAST) score. Major adverse cardiovascular events (MACE) were defined as a composite outcome of acute coronary syndrome or stroke.

Results

Among 642 MASLD patients (mean age 55.8 ± 12.5 years; 49.2% male, mean BMI 28.2 ± 4.7 kg/m2, 76% severe steatosis, 12.5% advanced fibrosis/cirrhosis [F3/F4]), 46.1% of patients fulfilled the diagnosis of clinical obesity. Clinical obesity criteria identified more patients with F3/F4 (20.6% vs 8.1%, p < 0.001), severe steatosis (83.8% vs 67.6%, p < 0.001), at-risk MASH (3.4% vs 0%, p = 0.056) and MACE (11.2% vs 2.7%, p = 0.006) compared with BMI-based criteria. Clinical obesity was an independent predictor of F3/F4 (OR 4.074, 95% CI 2.195–7.563, p < 0.001) and severe steatosis (OR 2.441, 95% CI 1.638–3.637, p < 0.001). Among patients with BIA, clinical obesity was associated with a lower appendicular skeletal muscle mass (27.0% vs 41.1%, P < 0.001) and a greater visceral fat index (15 vs 9, p < 0.001) compared with BMI-based criteria.

Conclusion

Clinical obesity criteria identified more MASLD patients with F3/F4, severe steatosis, at-risk MASH and MACE compared with BMI-based obesity criteria. It should be regularly utilized for prognostication in MASLD evaluation.