Abstract:

Objective To explore the association of multiple abnormal body compositions （sarcopenia， myosteatosis， visceral obesity， osteoporosis） with the risks of moderate-to-severe hepatic steatosis and significant liver fibrosis in patients with metabolic associated fatty liver disease （MAFLD）. Methods A retrospective study was conducted in 392 adult patients with MAFLD admitted to our hospital between June 2022 and June 2023. Based on liver fat content assessed by quantitative CT， the MAFLD patients were divided into a mild steatosis group （210 cases） and a moderate-to-severe steatosis group （182 cases）. General information and hematological indicators of all subjects were collected， and body composition was quantitatively evaluated using AI-based body composition analysis technology. Pearson or Spearman correlation analyses were employed to examine relationships between body composition parameters and hepatic fat content. Multivariate logistic regression analysis was used to determine whether abnormal body composition is an independent risk factor for moderate-to-severe hepatic steatosis and significant liver fibrosis. Results Compared to patients with mild hepatic steatosis， those with moderate-to-severe steatosis exhibited significantly higher prevalence of sarcopenia， visceral obesity， and osteoporosis （P < 0.05）. Skeletal muscle index（r = -0.131， P = 0.009）， muscle attenuation（r = -0.105， P = 0.038）， and bone mineral density （r = -0.135 P = 0.007）demonstrated inverse correlations with hepatic fat content， while intermuscular fat fraction（r = 0.121， P = 0.016）， visceral fat index（r = 0.434， P < 0.001）， and subcutaneous fat index（r = 0.289， P < 0.001）showed positive correlations. After adjusting for multiple confounders， osteoporosis（OR = 2.04， 95%CI ： 1.03 ~ 4.03， P = 0.041）， sarcopenia（OR = 2.19， 95%CI ： 1.37 ~ 3.52， P = 0.001）， and visceral obesity（OR = 1.84， 95%CI ： 1.08 ~ 3.15， P = 0.026） were all independent risk factors for moderate-to-severe hepatic steatosis. Additionally， after bias adjustment， osteoporosis（OR = 2.63， 95%CI ： 1.37 ~ 5.05， P = 0.004），sarcopenia（OR =1.94， 95%CI ： 1.28 ~ 2.94， P = 0.002） and visceral obesity（OR = 2.54， 95%CI ： 1.58 ~ 4.08， P < 0.001）were also independent risk factors for significant liver fibrosis. Conclusion Patients with moderate-to-severe MAFLD are predisposed to concurrent body composition abnormalities， including sarcopenia. Importantly，osteoporosis， sarcopenia and visceral obesity are not only key independent risk factors for moderate-to-severe hepatic steatosis， but also significantly increase the risk of liver fibrosis. Early identification， prevention， and intervention should be implemented.

Key words: metabolic associated fatty liver disease, sarcopenia, visceral obesity, body composition