A comparison of the predictive value of 12 body composition markers for MASLD, at-risk MASH and increased liver stiffness in a general population setting

Background: Adipose tissue is a key mediator of metabolic dysfunction-associated steatotic liver disease (MASLD) development and progression into metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis. Since direct comparisons of body composition parameters are lacking, we here investigate 12 different body composition parameters. Methods: Adult participants from NHANES 2017-2023 with liver health data were included. Exclusion criteria were age >80 years, excessive alcohol (>60gr/day), viral hepatitis and missing anthropometrics. MASLD was defined as CAP ≥275 dB/m with metabolic dysfunction, MASH as FibroScan-AST (FAST) ≥0.35, and increased liver stiffness measurement (LSM) as ≥8 kPa. Predictive performance of 12 body composition parameters was assessed using AUC-analysis. Predicted probabilities of outcomes were visualized for standardized parameters, and non-linearity was assessed via restricted cubic splines. Results: Among 11,579 participants (age 51[35-63], 47% male); 41% had MASLD, 6.5% at-risk MASH and 9.9% increased LSM. Waist circumference (WC) and not BMI or waist-to-height-ratio obtained the highest AUC for MASLD (0.82), at-risk MASH (0.73) and increased LSM (0.75) outperforming or equalling all other indices across subgroups. Associations between WC and MASLD were non-linear, with slight risk saturation beyond 100 cm; at-risk MASH was linearly associated across the entire spectrum; increased LSM risk rose only after WC >100 cm. Conclusion: In the general population, MASLD and MASH risk increased even when WC < 100 cm, while increased LSM risk was increasing only >100 cm. Although relatively minor differences, WC consistently demonstrated the highest predictive value for MASLD, at-risk MASH, and increased LSM and therefore most suited for MASLD diagnosis, management and risk stratification.