BackgroundObesity is a significant risk factor for the progression of non‐alcoholic fatty liver disease (NAFLD). However, a convenient and efficacious non‐invasive test for monitoring NAFLD progression in patients with obesity is currently lacking. This study aims to investigate the associations between CT‐based body composition and the progression of biopsy‐proven NAFLD in patients with obesity.MethodsLiver biopsy was conducted in patients with obesity, and the progression of NAFLD was evaluated by the NAFLD activity score (NAS). Body composition was assessed through abdominal computed tomography (CT) scans.ResultsA total of 602 patients with an average age of 31.65 (±9.33) years old were included, comprising 217 male patients and 385 female patients. The wall skeletal muscle index (SMI), total SMI, and visceral fat index (VFI) were positively correlated with NAS in both male and female patients. Multivariate regression analysis demonstrated significant associations between high liver steatosis and wall SMI (HR: 1.60, 95% CI: 1.12 to 2.30), total SMI (HR: 1.50, 95% CI: 1.02 to 2.08), VSI (HR: 2.16, 95% CI: 1.48 to 3.14), visceral fat to muscle ratio (HR: 1.51, 95% CI: 1.05 to 2.18), and visceral to subcutaneous fat ratio (HR: 1.51, 95% CI: 1.07 to 2.12). Non‐alcoholic steatohepatitis (NASH) was significantly associated with wall SMI (HR: 1.52, 95% CI: 1.06 to 2.19) and VSI (HR: 1.50, 95% CI: 1.03 to 2.17). Liver fibrosis ≥ F2 was significantly associated with psoas muscle index (HR: 0.64, 95% CI: 0.44 to 0.93) and psoas skeletal muscle density (HR: 0.61, 95% CI: 0.41 to 0.89).ConclusionsOur study suggested that certain CT‐based body composition indicators, notably high VFI, were significantly associated with the progression of NAFLD in patients with obesity. Great attentions and timely managements should be given to these patients with body composition characteristics associated with the risk of NAFLD progression.

中文翻译：

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肥胖患者活检证实的非酒精性脂肪肝的体成分和进展


背景肥胖是非酒精性脂肪性肝病 （NAFLD） 进展的重要危险因素。然而，目前缺乏一种方便有效的非侵入性测试来监测肥胖患者的 NAFLD 进展。本研究旨在调查基于 CT 的身体成分与肥胖患者经活检证实的 NAFLD 进展之间的关联。方法对肥胖患者进行肝活检，通过 NAFLD 活动评分 （NAS） 评估 NAFLD 的进展。通过腹部计算机断层扫描 （CT） 评估身体成分。结果共纳入 602 例患者，平均年龄 31.65 （±9.33） 岁，其中男性 217 例，女性 385 例。男性和女性患者的壁骨骼肌指数 （SMI） 、总 SMI 和内脏脂肪指数 （VFI） 与 NAS 呈正相关。多变量回归分析显示，高肝脂肪变性与壁 SMI （HR： 1.60， 95% CI： 1.12 至 2.30）、总 SMI （HR： 1.50， 95% CI： 1.02 至 2.08）、VSI （HR： 2.16， 95% CI： 1.48 至 3.14）、内脏脂肪与肌肉比 （HR： 1.51， 95% CI： 1.05 至 2.18） 和内脏与皮下脂肪比 （HR： 1.51,95% CI：1.07 至 2.12）。非酒精性脂肪性肝炎 （NASH） 与壁 SMI （HR： 1.52， 95% CI： 1.06 至 2.19） 和 VSI （HR： 1.50， 95% CI： 1.03 至 2.17） 显著相关。F2 ≥肝纤维化与腰大肌指数 （HR： 0.64， 95% CI： 0.44 至 0.93） 和腰大肌骨骼肌密度 （HR： 0.61， 95% CI： 0.41 至 0.89） 显著相关。结论我们的研究表明，某些基于 CT 的体成分指标，尤其是高 VFI，与肥胖患者 NAFLD 的进展显著相关。 应高度关注和及时管理这些具有与 NAFLD 进展风险相关的身体成分特征的患者。