Association between weight-adjusted-waist index with hepatic steatosis and liver fibrosis: a nationally representative cross-sectional study from NHANES 2017 to 2020

Abstract

BackgroundThe negative effects of obesity on hepatic steatosis and fibrosis have received considerable attention in recent years. The weight-adjusted-waist index (WWI) reflects weight-independent centripetal obesity. Herein, we provide the first investigation of a link between WWI, hepatic steatosis, and liver fibrosis.MethodsWe used data from the National Health and Nutrition Examination Survey 2017-2020 to conduct a cross-sectional study. The linear relationship between WWI, controlled attenuation parameters, and liver stiffness measurements (LSM) was investigated using multivariate linear regression models. The nonlinear relationship was described using fitted smoothed curves and threshold effect analyses. Subgroup analyses were performed based on gender, age, body mass index, diabetes, hypertension, drinking, and smoking.ResultsThis population-based study included 7,594 people, 50.74% of whom were men and 49.26% of whom were women. Multivariate linear regression analysis revealed a significant positive relationship between WWI and hepatic steatosis [CAP, β=7.60, 95% confidence interval (CI) (4.42, 10.78), P<0.0001]. This positive association was stronger when excessive alcohol intake was present compared to when it was absent (P for interaction = 0.031), and when hypertension was present compared to when it was not (P for interaction = 0.014). The linear relationship between WWI and liver fibrosis was not statistically significant on multiple regression analysis [LSM, β=0.03, 95% CI (-0.26, 0.32), P=0.84]. However, a U-shaped association was seen between WWI and LSM, with a negative correlation when WWI< 10.92 and a positive correlation when WWI > 10.92.ConclusionWe report a strong association between WWI and hepatic steatosis, and suggest that it may potentially be used as a simple anthropometric index to predict hepatic steatosis.

Association between weight-adjusted waist index and non-alcoholic fatty liver disease: a population-based study

“…Building upon Shen et al's study, our research further evaluated the association of WWI with NAFLD, yielding significant positive associations. These findings provided further support for Shen et al's results [ 30 ], suggesting that WWI was a useful index for evaluating liver fat deposition. However, it is noteworthy that our study also identified a nonlinear relationship between WWI and NAFLD; whether in the entire population, men or women, there was a gradual attenuation of the positive association when WWI approached 10, which contrasted with Shen et al's findings.…”

“…They quantified liver fat deposition and fibrosis using vibration-controlled transient elastography and found a significant positive correlation of WWI with liver fat deposition. Moreover, by fitting the smooth curve, they also found a U-shaped nonlinear correlation of WWI with liver fibrosis, and on both sides of WWI equal to 10.92, the WWI-related liver fibrosis risk showed an opposite trend [ 30 ]. Building upon Shen et al's study, our research further evaluated the association of WWI with NAFLD, yielding significant positive associations.…”

“…Previous studies have found strong associations of WWI with cardiovascular diseases, type 2 diabetes, hyperuricemia, and adult urinary protein excretion [ 21 , 24 – 29 ]. However, the research on NAFLD and WWI is limited, with only one study published in May 2023 reporting an independent association between hepatic steatosis and WWI in a population of Americans [ 30 ]. Therefore, this study aimed to further explore the association of WWI with NAFLD using data from the NAGALA project.…”

Association between Weight-Adjusted Waist Index and Depression in NAFLD: The Modulating Roles of Sex and BMI

“…Substantial large-sample observational clinical studies have linked WWI to the development and comorbidities of a variety of clinical conditions, including NAFLD. A crosssectional analysis similarly using NHANES 2017-2020 suggested that WWI was associated with hepatic steatosis, independently of BMI [37]. Another cross-sectional study, also using NHANES 2017-2020, showed that WWI was signi cantly and positively associated with NAFLD and liver brosis [38].…”

The relationship between weight-adjusted-waist index and diabetic kidney disease in patients with type 2 diabetes mellitus

“…The WWI offers a more nuanced distinction between fat and muscle mass, focusing primarily on abdominal obesity independent of body weight (7,8). Additionally, emerging evidence has substantiated the notion that an elevation in the WWI index poses a substantial risk factor for metabolic disorders, including diabetes and non-alcoholic fatty liver disease (8)(9)(10)(11). Consequently, it is of paramount importance to delve deeper into its correlation with DKD within the diabetic population.…”