Adopting the Lancet commission definition of clinical obesity in metabolic dysfunction-associated steatotic liver disease (MASLD)
A new definition of clinical obesity was proposed by The Lancet Diabetes & Endocrinology Commission and applied to a cohort of Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD) to evalu
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. 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. Among 642 MASLD patients, 46.1% of patients fulfilled the diagnosis of clinical obesity. Clinical obesity criteria identified more patients with advanced fibrosis/cirrhosis and severe steatosis compared with BMI-based criteria. Clinical obesity was an independent predictor of F3/F4 and severe steatosis. Among patients with BIA, clinical obesity was associated with a lower appendicular skeletal muscle mass and a greater visceral fat index compared with BMI-based criteria. Clinical obesity criteria identified more MASLD patients with F3/F4, severe steatosis, at-risk MASH and MACE compared with BMI-based obesity criteria. This new definition of clinical obesity should be regularly utilized for prognostication in MASLD evaluation.