The Journal of Practical Medicine >

2026 , Vol. 42 >Issue 3: 438 - 446

DOI: https://doi.org/10.3969/j.issn.1006-5725.2026.03.011

Chronic Disease Control

Association between CT-quantified body composition and severity of metabolic associated fatty liver disease

  • Ying FENG ,
  • Saiqun LV ,
  • Xiaohui ZENG ,
  • Tao PENG
Expand
  • Department of Radiology，Affiliated Hospital of Chengdu University，Chengdu 610081，Sichuan，China

Received date: 2025-10-27

  Online published: 2026-02-09

Fold

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

Cite this article

Ying FENG , Saiqun LV , Xiaohui ZENG , Tao PENG . Association between CT-quantified body composition and severity of metabolic associated fatty liver disease[J]. The Journal of Practical Medicine, 2026 , 42(3) : 438 -446 . DOI: 10.3969/j.issn.1006-5725.2026.03.011

References

[1] ESLAM M， SANYAL A J， GEORGE J， et al. MAFLD： A consensus-driven proposed nomenclature for metabolic associated fatty liver disease［J］. Gastroenterology， 2020， 158（7）： 1999-2014.e1. doi： 10.1053/j.gastro.2019.11.312 .
[2] 佘莎，戴锴. 《APASL临床实践指南：代谢相关脂肪性肝病的诊断和治疗（2025年版）》更新要点解读［J］. 中国临床医生杂志，2025，53（5）： 51-54. doi： 10.3969/j.issn.2095-8552. 2025. 05.011 .
[3] ONISHI S， FUKUDA A， MATSUI M， et al. Body composition analysis in patients with metabolic dysfunction-associated fatty liver disease［J］. Nutrients， 2023， 15（18）： 3878. doi： 10.3390/nu15183878 .
[4] ZHANG X， HE Z， SI Q， et al. The association of sarcopenia and visceral obesity with lean nonalcoholic fatty liver disease in Chinese patients with type 2 diabetes mellitus［J］. J Diabetes Res， 2022， 2022： 2229139. doi： 10.1155/2022/2229139 .
[5] CHEN C， XIE L， ZHANG M， et al. The interplay between the muscle and liver in the regulation of glucolipid metabolism［J］. J Mol Cell Biol， 2024， 15（12）： mjad073. doi： 10.1093/jmcb/mjad073 .
[6] JUNG C H， RHEE E J， KWON H， et al. Visceral-to-subcutaneous abdominal fat ratio is associated with nonalcoholic fatty liver disease and liver fibrosis［J］. Endocrinol Metab， 2020， 35（1）： 165-176. doi：10.3803/EnM.2020.35.1.165 .
[7] HAO X Y， ZHANG K， HUANG X Y， et al. Muscle strength and non-alcoholic fatty liver disease/metabolic-associated fatty liver disease［J］.World J Gastroenterol， 2024， 30（7）： 636-643. doi： 10.3748/wjg.v30.i7.636 .
[8] TAO J， LI H， WANG H， et al. Metabolic dysfunction-associated fatty liver disease and osteoporosis： The mechanisms and roles of adiposity［J］. Osteoporos Int， 2024， 35（12）： 2087-2098. doi： 10.1007/s00198-024-07217-y .
[9] MOURTZAKIS M， PRADO C M M， LIEFFERS J R， et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care［J］. Appl Physiol Nutr Metab， 2008， 33（5）： 997-1006. doi： 10.1139/H08-075 .
[10] CAREY E J， LAI J C， WANG C W， et al. A multicenter study to define sarcopenia in patients with end-stage liver disease［J］. Liver Transpl， 2017， 23（5）： 625-633. doi： 10.1002/lt.24750 .
[11] HSIEH Y C， JOO S K， KOO B K， et al. Muscle alterations are independently associated with significant fibrosis in patients with nonalcoholic fatty liver disease［J］. Liver Int， 2021， 41（3）： 494-504. doi： 10.1111/liv.14719 .
[12] NACHIT M， HORSMANS Y， SUMMERS R M， et al. AI-based CT body composition identifies myosteatosis as key mortality predictor in asymptomatic adults［J］. Radiology， 2023， 307（5）： e222008. doi： 10.1148/radiol.222008 .
[13] KIM E H， KIM H K， LEE M J， et al. Sex differences of visceral fat area and visceral-to-subcutaneous fat ratio for the risk of incident type 2 diabetes mellitus［J］. Diabetes Metab J， 2022， 46（3）： 486-498. doi： 10.4093/dmj.2021.0195 .
[14] 中华医学会健康管理学分会， 国家骨科医学中心（首都医科大学附属北京积水潭医院）， 国家级放射影像专业质控中心， 等. 定量 CT 在健康管理中的应用指南（2024）［J］. 中华健康管理学杂志， 2024，18（9）： 645-654. doi：10.3760/cma.j.cn115624- 20240607-00474 .
[15] STERLING R K， LISSEN E， CLUMECK N， et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection［J］. Hepatology， 2006， 43（6）： 1317-1325. doi： 10.1002/hep.21178 .
[16] MUSIO A， PERAZZA F， LEONI L， et al. Osteosarcopenia in NAFLD/MAFLD： An underappreciated clinical problem in chronic liver disease［J］. Int J Mol Sci， 2023， 24（8）： 7517. doi： 10.3390/ijms24087517 .
[17] ZHOU T， YE J， LUO L， et al. Restoring skeletal muscle mass as an independent determinant of liver fat deposition improvement in MAFLD［J］. Skeletal Muscle， 2023， 13（1）： 23. doi： 10.1186/s13395-023-00333-z .
[18] KIM G， LEE S， LEE Y， et al. Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease： A 7-year longitudinal study［J］. Hepatology， 2018， 68（5）： 1755-1768. doi： 10.1002/hep.30049 .
[19] VISWANATH A， FOUDA S， FERNANDEZ C J， et al. Metabolic-associated fatty liver disease and sarcopenia： A double whammy［J］. World J Hepatol， 2024， 16（2）： 152-163. doi： 10.4254/wjh.v16.i2.152 .
[20] FENG Z， ZHAO F， WANG Z， et al. The relationship between sarcopenia and metabolic dysfunction-associated fatty liver disease among the young and middle-aged populations［J］. BMC Gastroenterol， 2024， 24（1）： 111. doi： 10.1186/s12876-024-03192-0 .
[21] MALIK A， JAVAID S， MALIK M I， et al. Relationship between sarcopenia and metabolic dysfunction-associated steatotic liver disease （MASLD）： A systematic review and meta-analysis［J］. Ann Hepatol， 2024， 29： 101544. doi： 10.1016/j.aohep. 2024. 101544 .
[22] FERENC K， JARMKIEWICZ-CZAJA S， FILIP R. What does sarcopenia have to do with nonalcoholic fatty liver disease？［J］. Life， 2023， 14： 37. doi： 10.3390/life14010037 .
[23] LOSASSO M R， PARUSSOLO M L C， SILVA A O， et al. Unraveling the metabolic pathways between metabolic-associated fatty liver disease （MAFLD） and sarcopenia［J］.Int J Mol Sci， 2025， 26（10）： 4673. doi： 10.3390/ijms26104673 .
[24] KIM T H， JEONG C W， LEE C， et al. Association between body composition contents and hepatic fibrosis in sarcopenic obesity［J］. J Clin Med， 2023， 12（13）： 4279. doi： 10.3390/jcm12134279 .
[25] LEE S， KIM K W， LEE J， et al. Reduction of visceral adiposity as a predictor for resolution of nonalcoholic fatty liver in potential living liver donors［J］. Liver Transpl， 2021， 27（10）： 1424-1431. doi： 10.1002/lt.26071 .
[26] KEN?EL JOVANOVI? G， MRAKOVCIC-SUTIC I， PAVI?I? ?E?ELJ S， et al. Metabolic and hepatic effects of energy-reduced anti-inflammatory diet in younger adults with obesity［J］. Can J Gastroenterol Hepatol， 2021， 2021：6649142. doi： 10.1155/2021/6649142 .
[27] HONG Y， CHEN X， WANG L， et al. Machine learning prediction of metabolic dysfunction-associated fatty liver disease risk in American adults using body composition： Explainable analysis based on SHapley Additive exPlanations［J］. Front Nutr， 2025， 12： 1616229. doi： 10.3389/fnut.2025.1616229 .
[28] MáTIS D， HEGYI P， TEUTSCH B， et al. Improved body composition decreases the fat content in non-alcoholic fatty liver disease， a meta-analysis and systematic review of longitudinal studies［J］. Front Med， 2023， 10： 1114836. doi： 10.3389/fmed. 2023.1114836 .
[29] YOKOKAWA H， FUKUDA H， SAITA M， et al. An association between visceral or subcutaneous fat accumulation and diabetes mellitus among Japanese subjects［J］. Diabetol Metab Syndr， 2021， 13（1）： 44. doi： 10.1186/s13098-021-00646-3 .
[30] ELGUEZABAL RODELO R G， PORCHIA L M， TORRAS-RASGADO E， et al. Visceral and subcutaneous abdominal fat is associated with non-alcoholic fatty liver disease while augmenting metabolic syndrome's effect on non-alcoholic fatty liver disease： A cross-sectional study of NHANES 2017–2018［J］. PLoS One， 2024， 19（2）： e0298662. doi： 10.1371/journal.pone.0298662 .
[31] ZHANG W， LI Y， LI S， et al. Associations of metabolic dysfunction-associated fatty liver disease and hepatic fibrosis with bone mineral density and risk of osteopenia/osteoporosis in T2DM patients［J］. Front Endocrinol， 2023， 14： 1278505. doi： 10.3389/fendo.2023.1278505 .
Options
Outlines

/

〈 〉