Regional anthropometric measures and hepatic fibrosis in patients with nonalcoholic Fatty liver disease

Abstract

Background & aims: In overnourished individuals, impaired peripheral fat storage (ie, reduced fat mass in extremities) can increase delivery of surplus calories to the organs other than peripheral adipose tissues, including the liver (ie, lipid overload), and facilitate disease progression in patients with nonalcoholic fatty liver disease (NAFLD). We investigated whether peripheral and/or abdominal adipose depot size correlates with stage of hepatic fibrosis in patients with NAFLD in sex- and/or menopausal stage-specific manners.

Methods: We performed a cross-sectional analysis of 537 adult patients with NAFLD. Peripheral adipose depot size was defined as the sum of z-scores of 2 anthropometric parameters (middle upper arm circumference and hip circumference, relative to total body size) and expressed as extremity size. Abdominal adipose depot size was defined as waist circumference. Peripheral and abdominal adipose depot sizes were associated with fibrosis stage(s) (F0-F4) using multivariable analyses separately for men and pre- and post-menopausal women.

Results: After adjusting for caloric intake and energy expenditure during physical activity (MET; hours/week), peripheral and/or abdominal adipose depot sizes were differentially associated with fibrosis stages in men and pre- and post-menopausal women. Men with smaller extremity size, premenopausal women with larger extremity size, and postmenopausal women with larger abdominal size were more likely to have higher stages of fibrosis.

Conclusions: In patients with NAFLD, regional anthropometric measures are associated with fibrosis severity in a sex- and menopausal stage-specific manner. Unlike premenopausal women, men with NAFLD who have small peripheral adipose depots are at an increased risk of having advanced fibrosis.

Figure 1

The association between regional anthropometric parameters and hepatic fibrosis after adjusting for total calorie intake and physical activity levels. (A) Men, (B) premenopausal women, and (C) postmenopausal women depict the associations between severity of hepatic fibrosis and parameters of peripheral and abdominal adipose depot sizes after taking into consideration the magnitude of excess energy. In each figure, the horizontal axis represents fibrosis stages, and the vertical axis represents beta coefficients and 95% confidence intervals (bars and lines) from the multiple linear regression models.