Body composition parameters and comorbidities as markers of clinically significant liver fibrosis (F2, F3 stages) in patients with metabolic dysfunction-associated steatotic liver disease

Abstract

Abstract. The global incidences of metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity are increasing. Liver fibrosis stage is considered the strongest predictor of disease-specific mortality in MASLD. Aim. This study aimed to examine the possible associations between body composition parameters assessed by bioimpedance analysis (BIA), comorbidities, and clinically significant liver fibrosis (F2, F3) in Ukrainian patients with MASLD. Material and methods. It was an observational study involving adult patients aged ≥18 years with a diagnosis of MASLD and liver steatosis, confirmed by ultrasound imaging, who underwent liver shear-wave elastography for assessment of liver fibrosis and body composition assessment. Logistic regression analysis was performed to determine possible factors associated with clinically significant liver fibrosis (F2, F3). Results. The study included 79 patients with a mean age of 45.66±14.26 years, and 64.6% were female. The body mass index (BMI) median was 31.9 kg/m2 (Q1, Q3: 29.25, 37.3) and clinically significant liver fibrosis (F2, F3) was observed in 15.2% of patients (n=12). Patients with F2, F3 stages had higher BMI (median=37.55; Q1, Q3: 33.11, 42.45) than patients without clinically significant liver fibrosis (median=31.2; Q1, Q3: 28.63, 35.35; p=0.0027). Excessive visceral fat level was associated with clinically significant liver fibrosis (F2, F3) (odds ratio [OR]=5.74, 95% confidence interval (CI): 1.41-23.29, p=0.0145). We found that type 2 diabetes (T2D) was significantly associated with clinically significant liver fibrosis (F2, F3) in patients with MASLD (OR=4.15, 95% CI: 1.15-14.99, p=0.0297) and this association remained significant after adjustment for age and sex, as well as in the multivariable model. Conclusion. We demonstrated that a high-er visceral fat level was associated with clinically significant liver fibrosis (F2, F3), suggesting that the presence of excessive visceral fat accumulation determined with BIA may be used as a potential marker of clinically significant liver fibrosis (F2, F3) in patients with MASLD. Our study also confirmed the link between T2D and significant liver fibrosis (F2, F3) in Ukrainian adults with MASLD. These findings demonstrate the importance of timely screening of this category of patients for liver fibrosis, as recommended by the current guidelines.