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TOPLINE:

A U-shaped relationship was found between BMI and the risk for elevated liver stiffness in older adults, with both lower and higher BMI tied to an increased risk. An optimal BMI range of 21.8-24.3 was associated with the lowest risk for elevated liver stiffness, as measured by transient elastography.

METHODOLOGY:

• Recent evidence increasingly links obesity to elevated liver stiffness, though associations at lower BMIs remain inconsistent. Prior studies largely relied on single‐point BMI measurements and thus overlooked the potential impact of long‐term BMI trends on liver stiffness risk.
• Researchers conducted a cohort study to examine the association between long-term BMI patterns and the risk for liver stiffness in 2736 participants aged 60 years or older with at least three physical exams between 2017 and 2022; those with chronic liver disease, alcoholism, failed liver stiffness tests, etc., were excluded.
• The 5-year average BMI was categorized into quintiles: quintile 1 (≤ 21.92), quintile 2 (21.93-23.58), quintile 3 (23.59-24.92), quintile 4 (24.93-26.79), and quintile 5 (≥ 26.80).
• Liver stiffness was measured at baseline using transient elastography, with values > 7.0 kPa indicating elevated liver stiffness.

TAKEAWAY:

• Participants in BMI quintile 2 had the lowest prevalence of elevated liver stiffness (7.5%); those in higher BMI quintiles had an increased risk for liver stiffness than those in quintile 2 (quintile 4 vs quintile 2: adjusted odds ratio [aOR], 2.05; 95% CI, 1.37-3.11; quintile 5 vs quintile 2: aOR, 2.82; 95% CI, 1.78-4.39).
• From 2017 to 2022, five BMI trajectories were identified: low- to normal-weight stable (7.42%), moderate- to normal-weight stable (29.10%), low-level overweight stable (36.22%), high-level overweight stable (20.32%), and stable obesity (6.94%).
• Compared with the moderate- to normal-weight stable group, the stable obesity group showed the highest prevalence of elevated liver stiffness (aOR, 2.83; 95% CI, 1.72-4.64), followed by the high-level overweight stable group (aOR, 2.02; 95% CI, 1.39-2.97).
• Restricted cubic spline analysis revealed a U-shaped relationship, with the lowest risk for elevated liver stiffness at a BMI of 21.8-24.3 and a higher risk at both lower and higher BMI values.

IN PRACTICE:

“Both maintaining lower and higher weights for 5 years increased the risk of elevated liver stiffness and the optimal BMI range from 21.8 to 24.3 kg/m² for the lowest risk of elevated liver stiffness in older people,” the authors of the study wrote.

SOURCE:

This study was led by Liang Lv, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. It was published online in the International Journal of Obesity.

LIMITATIONS:

Liver biopsy, the gold standard for diagnosing liver fibrosis, was not performed to verify the effectiveness of transient elastography measurements. Liver stiffness was not measured continuously over the 5-year period. Additionally, the study’s findings may not be directly applicable to other ethnicities because all participants were Chinese.

DISCLOSURES:

This study received funding from National Key R&D Program of China. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.