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

Figures & data

Figure 1 Flow chart of evaluated participants with fatty liver.

Table 1 Characteristics of Study Participants According to Obesity Phenotypes

	MHNO	MUNO	MHO	MUO	p value
	(n=580)	(n=671)	(n=131)	(n=435)
Age (years)	72.1 ± 5.8	73.3 ± 5.9^†	73.0 ± 5.6	73.2 ± 6.0^†	0.001
Female (%)	345 (59.5)	499 (74.4)	82 (62.6)	304 (69.9)	<0.001
BMI (kg/m^2)	23.8 ±1.8	24.6 ±1.6^†	29.1 ± 2.2^†‡	29.6 ± 2.4^†‡	<0.001
Waist circumference (cm)	81.2 ± 6.7	85.3 ± 6.5^†	92.9 ± 8.9^†‡	94.2 ± 9.4^†‡	<0.001
Systolic BP (mmHg)	134.5 ± 19.8	141.5 ± 20.7^†	137.6 ± 18.4	146.0 ± 20.0^†‡§	<0.001
Diastolic BP (mmHg)	69.4 ± 10.6	72.4 ± 10.4^†	71.9 ± 11.1	74.2 ± 9.9^†‡	<0.001
Glucose (mg/dL)	101.7 ± 18.1	115.4 ± 26.4^†	99.8 ± 14.5^‡	117.3 ± 23.1^†§	<0.001
Total cholesterol (mg/dL)	102.4 ± 40.0	152.1 ± 76.3^†	98.8 ± 37.0^‡	138.0 ± 64.0^†§	<0.001
HDL-C (mg/dL)	60.0 ± 14.4	50.7 ± 13.2^†	59.3 ± 12.2^‡	51.9 ± 11.9^†§	<0.001
LDL-C (mg/dL)	118.2 ± 31.0	112.4 ± 32.9^†	124.3 ± 32.8^‡	112.2 ± 30.4^†§	<0.001
Triglyceride (mg/dL)	102.4 ± 40.0	152.1 ± 76.3^†	98.8 ± 37.0^‡	138.0 ± 64.0^†‡§	<0.001
AST (U/L)	23.5 ± 7.1	24.4 ± 9.2	25.1 ± 9.7	25.4 ± 10.4^†	0.013
ALT (U/L)	21.3 ± 10.2	23.4 ± 12.4 ^†	22.5 ± 11.2	25.3 ± 14.3^†	<0.001
Albumin (mg/dL)	4.3 ± 0.2	4.3 ± 0.2	4.2 ± 0.2^†‡	4.3 ± 0.2	<0.001
Platelet (×10^9/L)	218.4 ± 51.1	222.0 ± 50.6	209.2 ± 50.0	220.0 ± 58.5	0.08
Smoking habit					0.63
Nonsmoker (%)	557 (96.0)	648 (96.6)	129 (98.5)	425 (97.7)
Social smoker (%)	9 (1.6)	8 (1.2)	0 (0)	3 (0.7)
Current smoker (%)	14 (2.4)	15 (2.2)	2 (1.5)	7 (1.6)
Alcohol consumption					0.028
No drinking (%)	506 (87.2)	617 (92.0)	113 (86.3)	392 (90.1)
Social drinking (%)	74 (12.8)	54 (8.0)	18 (13.7)	43 (9.9)
Diabetes mellitus (%)	39 (6.7)	159 (23.7)	4 (3.1)	119 (27.4)	<0.001
Hypertension (%)	214 (36.9)	394 (58.7)	56 (42.7)	332 (76.3)	<0.001
Hyperlipidemia (%)	62 (10.7)	218 (32.5)	4 (3.1)	143 (32.9)	<0.001
Total numbers of metabolic factors					<0.001
None (%)	45 (7.8)	0 (0)	3 (2.3)	0 (0)
One factor (%)	187 (32.2)	0 (0)	17 (13.1)	0 (0)
Two factors (%)	348 (60.0)	0 (0)	111 (87.4)	0 (0)
Three factors (%)	0 (0)	360 (53.7)	0 (0)	198 (45.5)
Four factors (%)	0 (0)	226 (33.7)	0 (0)	161 (37.0)
Five factors (%)	0 (0)	88 (12.8)	0 (0)	85 (12.7)
Fatty liver					<0.001
Mild (%)	551 (95.0)	584 (87.0)	107 (81.7)	299 (68.7)
Moderate-to-severe (%)	29 (5.0)	87 (13.0)	24 (18.3)	136 (31.3)
NFS	−0.840 ± 1.0	−0.361 ± 1.0^†	−0.292 ± 0.9^†	0.176 ± 0.4^†‡§	<0.001
NFS category					<0.001
No-mild fibrosis (NFS ≤ 0.676) (%)	541 (93.3)	585 (87.2)	114 (87.0)	303 (69.7)
Advanced fibrosis (NFS > 0.676) (%)	39 (6.7)	86 (12.8)	17 (13.0)	132 (30.3)
FIB-4	1.84 ± 0.8	1.83 ± 0.7	1.82 ± 0.9	1.98 ± 0.7	0.20
FIB-4 category					0.031
No-mild fibrosis (FIB-4 ≤ 2.67) (%)	532 (91.7)	607 (90.5)	109 (83.2)	393 (90.3)
Advanced fibrosis (FIB-4 > 2.67) (%)	48 (8.3)	64 (9.5)	22 (16.8)	42 (9.7)

Notes: Data are presented as number (percentage) or mean ± standard deviation; p-values calculated using chi-square tests for categorical variables and analysis of variance tests for the continuous variables; ^†different from MHNO phenotype (p < 0.05); ^‡different from MUNO phenotypes (p < 0.05); ^§different from MHO phenotype (p < 0.05).

Abbreviations: BMI, body mass index; BP, blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; AST, aspartate aminotransaminase; ALT, alanine transaminase; NFS, NAFLD fibrosis score; FIB-4, fibrosis-4 score; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.

Table 2 Univariate Analysis and Multivariate Analysis for Advanced Fibrosis Using NFS (>0.676) According to Obese Phenotypes

	MHNO	MUNO	MHO	MUO
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
NFS category	1 (reference)	2.03 (1.37−3.02)*	2.09 (1.14−3.82)*	6.04 (4.12−8.87)*
Model 1	1 (reference)	2.37 (1.58−3.56)*	2.16 (1.18−3.98)*	6.59 (4.46−9.75)*
Model 2	1 (reference)	2.39 (1.59−3.61)*	2.13 (1.15−3.93)*	6.58 (4.44−9.74)*
Model 3	1 (reference)	2.43 (1.50−3.93)*	2.35 (1.25−4.41.)*	6.11 (3.90−9.59)*

Notes: *Different from MHNO phenotype (p < 0.05); Multivariate-adjusted model 1 was adjusted for sex; multivariate-adjusted model 2 was adjusted for sex, smoking status and alcohol consumption; multivariate-adjusted model 3 was adjusted for sex, smoking status, alcohol consumption, fasting glucose, total cholesterol, triglyceride and high-density lipoprotein cholesterol.

Abbreviations: NFS, NAFLD fibrosis score; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese; OR, odds ratios.

Table 3 Subgroup Analysis Stratified by Sex for Advanced Fibrosis Using NFS (>0.676) Category

	MHNO	MUNO	MHO	MUO
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Women
NFS category	1 (reference)	2.05 (1.16−3.62)*	2.09 (0.87−5.12)	7.01 (4.04−12.15)*
Model 2	1 (reference)	2.04 (1.15−3.62)*	2.03 (0.84−4.88)	7.08 (4.08−12.27)*
Model 3	1 (reference)	1.60 (0.81−3.17)	2.08 (0.84−5.14)	4.70 (2.53−8.72)*
Men
NFS category	1 (reference)	2.73 (1.55−4.81)*	2.23 (0.96−5.21)	6.17 (3.52−10.83)*
Model 2	1 (reference)	2.79 (1.57−4.94)*	2.21 (0.94−5.21)	6.10 (3.47−10.73)*
Model 3	1 (reference)	3.12 (1.56−6.23)*	2.42 (0.99−5.92)	8.06 (4.14−15.70)*

Notes: *Different from MHNO phenotype (p < 0.05); multivariate-adjusted model 2 was adjusted for smoking status and alcohol consumption; multivariate-adjusted model 3 was adjusted for smoking status, alcohol consumption, fasting glucose, total cholesterol, triglyceride and high-density lipoprotein cholesterol.

Abbreviations: NFS, NAFLD fibrosis score; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese; OR, odds ratios.

Table 4 Univariate Analysis and Multivariate Analysis for Advanced Fibrosis Using FIB-4 (>2.67) According to Obese Phenotypes

	MHNO	MUNO	MHO	MUO
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
FIB-4 category	1 (reference)	1.16 (0.79−1.72)	2.26 (1.31−3.90)*	1.18 (0.77−1.83)
Model 1	1 (reference)	1.32 (0.89−1.97)	2.32 (1.34−4.02)*	1.28 (0.83−1.99)
Model 2	1 (reference)	1.33 (0.89−1.99)	2.31 (1.33−4.00)*	1.28 (0.82−1.98)
Model 3	1 (reference)	1.34 (0.83−2.18)	2.37 (1.36−4.13)*	1.38 (0.82−2.31)

Notes: *Different from MHNO phenotype (p < 0.05); multivariate-adjusted model 1 was adjusted for sex; multivariate-adjusted model 2 was adjusted for sex, smoking status and alcohol consumption; multivariate-adjusted model 3 was adjusted for sex, smoking status, alcohol consumption, fasting glucose, total cholesterol, triglyceride and high-density lipoprotein cholesterol.

Abbreviations: FIB-4, fibrosis-4 score; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese; OR, odds ratios.

Table 5 Subgroup Analysis Stratified by Sex for Advanced Fibrosis Using FIB-4 (>2.67) Category

	MHNO	MUNO	MHO	MUO
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Women
FIB-4 category	1 (reference)	1.45 (0.82−2.56)	3.84 (1.86−7.95)*	1.54 (0.83−2.85)
Model 2	1 (reference)	1.44 (0.82−2.54)	3.80 (1.84−7.86)*	1.54 (0.83−2.86)
Model 3	1 (reference)	1.60 (0.82−3.12)	3.70 (1.78−7.71)*	1.82 (0.87−3.77)
Men
FIB-4 category	1 (reference)	1.20 (0.68−2.13)	1.21 (0.50−2.96)	1.06 (0.56−2.01)
Model 2	1 (reference)	1.22 (0.69−2.18)	1.20 (0.49−2.94)	1.05 (0.55−1.99)
Model 3	1 (reference)	1.09 (0.52−2.26)	1.22 (0.48−3.05)	1.82 (0.87−3.77)

Notes: *Different from MHNO phenotype (p < 0.05); multivariate-adjusted model 2 was adjusted for smoking status and alcohol consumption; multivariate-adjusted model 3 was adjusted for smoking status, alcohol consumption, fasting glucose, total cholesterol, triglyceride and high-density lipoprotein cholesterol.

Abbreviations: FIB-4, fibrosis-4 score; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese; OR, odds ratios.