{
  "abstract": "Objective Although body mass index (BMI)-defined non-obesity metabolic dysfunction-associated steatotic liver disease (MASLD) predicts poor prognosis, the role of visceral adiposity and weight-based phenotypes is unclear. This study aimed to examine the clinical correlates of four unique MASLD phenotypes based on BMI and waist-to-height ratio (WHtR) and to assess the prognostic value of this classification with respect to mortality.Design Population-based cross-sectional study with prospective mortality follow-up.Setting Nationally representative US population derived from the National Health and Nutrition Examination Survey (NHANES), 2007–2018.Participants 6300 adults with MASLD, sampled from NHANES 2007 to 2018.Methods Participants were allocated into four phenotypes based on obesity/lean and central adiposity status. Obesity was defined as BMI≥30 kg/m², while those without obesity were determined as lean. High central adiposity was defined as WHtR≥0.6.Primary outcome measure The primary outcome was all-cause mortality. This was ascertained through National Death Index linkage with follow-up censored at 31 December 2019.Results Among adults with MASLD, 72.1% had obesity with high central adiposity (mean follow-up: 6.9±3.5 years). The non-obesity, high central adiposity phenotype (9.6%) exhibited the highest rates of hypertension (60.2%), type 2 diabetes (31.8%) and chronic kidney disease (23.3%). This phenotype portended the poorest 6-year survival (p<0.001) and was independently associated with higher all-cause mortality (adjusted HR (aHR) 3.1, 95% CI 1.3 to 7.7). A J-shaped association was observed between BMI and mortality, with increasing WHtR linked to elevated risk.Conclusion Non-obesity MASLD with high central adiposity confers the poorest survival and cardiometabolic burden.",
  "authors": [
    {
      "affiliations": [
        "Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, George Town, Malaysia"
      ],
      "name": "Martin Tze Wah Kueh"
    },
    {
      "affiliations": [
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Made Ayu Utami Intaran"
    },
    {
      "affiliations": [
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Rachel Goh"
    },
    {
      "affiliations": [
        "Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Gwyneth Kong"
    },
    {
      "affiliations": [
        "Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, George Town, Malaysia"
      ],
      "name": "Hui Lian Koh"
    },
    {
      "affiliations": [
        "Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Yip Han Chin"
    },
    {
      "affiliations": [
        "Department of Cardiology, National University Heart Centre, National University Health System, Singapore"
      ],
      "name": "Mark Y Chan"
    },
    {
      "affiliations": [
        "Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland",
        "Diabetes Research Centre, Ulster University, Coleraine, UK"
      ],
      "name": "Carel W Le Roux"
    },
    {
      "affiliations": [
        "Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA"
      ],
      "name": "Anurag Mehta"
    },
    {
      "affiliations": [
        "Baylor Scott and White Research Institute, Dallas, Texas, USA",
        "Department of Medicine, Baylor College of Medicine, Temple, Texas, USA",
        "Division of Cardiology, Heart Hospital Plano, Plano, Texas, USA"
      ],
      "name": "Muhammad Shahzeb Khan"
    },
    {
      "affiliations": [
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Mark D Muthiah"
    },
    {
      "affiliations": [
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Department of Cardiology, National University Heart Centre, National University Health System, Singapore"
      ],
      "name": "Nicholas WS Chew"
    }
  ],
  "title": "Body weight categories and fat distribution in relation to all-cause mortality among adults with metabolic dysfunction-associated steatotic liver disease: a population-based analysis of NHANES, 2007–2018",
  "uid": "f050368e-fb07-5016-83f8-d822fa05cb94"
}