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The Association Between Different Obesity Phenotypes and Liver Fibrosis Scores in Elderly Individuals with Fatty Liver in Taiwan

Authors Lee YS, Hwang LC, Hsu HY, Tsou MT

Received 19 January 2021

Accepted for publication 11 March 2021

Published 30 March 2021 Volume 2021:14 Pages 1473—1483


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ming-Hui Zou

Yu-Shan Lee,1 Lee-Ching Hwang,1,2 Hsin-Yin Hsu,1 Meng-Ting Tsou1,3

1Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 2Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; 3Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan

Correspondence: Meng-Ting Tsou
Department of Family Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Road, Taipei City, 10449, Taiwan, R.O.C.
Tel +886 2 2543 3535 (Ext. 2131 or 2132)
Fax +886 2 2543 3642
Email [email protected]

Purpose: To examine the association between different phenotypes of obesity or metabolic syndromes and liver fibrosis score in a Taiwanese elderly population with fatty liver.
Patients and Methods: This cross-sectional study included 1817 participants aged ≥ 65 years with fatty liver diagnosed by sonography. We used ethnicity-specific criteria for body mass index and metabolic syndrome, and to define obesity phenotypes as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Correlated fibrosis severity was calculated using the nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and Fibrosis-4 (FIB-4). Fibrosis severity was divided into two categories according to NFS (no-to-mild fibrosis and advanced fibrosis, defined as NFS ≤ 0.676 and > 0.676, respectively) and FIB-4 score (no-to-mild fibrosis and advanced fibrosis, defined as FIB-4 score ≤ 2.67 and > 2.67, respectively).
Results: Compared with that in the MHNO group, the associated risk (odds ratio [OR], 95% confidence interval [CI]) of advanced fibrosis by NFS was 2.43 (1.50– 3.93), 2.35 (1.25– 4.41), and 6.11 (3.90– 9.59), whereas that of advanced fibrosis by FIB-4 score was 1.34 (0.83– 2.18), 2.37 (1.36– 4.13), and 1.38 (0.82– 2.31) in the MUNO, MHO, and MUO groups, respectively.
Conclusion: Both metabolic syndrome and obesity were positively associated with more advanced fibrosis according to NFS. The detrimental effect of obesity appears to be more than metabolic abnormalities per se in the elderly with more advanced fibrosis severity according to the FIB-4 score.

Keywords: nonalcoholic fatty liver disease, obese phenotype, elderly population, NAFLD fibrosis score, Fibrosis-4

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