Abstract
BACKGROUND: Recent clinical consensus statements have emphasized a shift from diagnosing obesity with body mass index (BMI) requiring confirmation with surrogate markers such as waist circumference-to-height ratio (WHtR). WHtR is a highly sensitive and specific predictor of dual-energy X-ray absorptiometry-measured total body fat mass and abdominal fat mass but not lean mass. However, newly developed WHtR adiposity cut points warrant external validation before clinical application. OBJECTIVE: To examine whether new WHtR cut points predict liver steatosis and fibrosis in a multiracial population. METHODS: Data from 6464 (54% female) multiracial US participants from the National Health and Nutrition Examination Survey conducted between 2021 and 2023 were analyzed. Liver fibrosis was assessed with transient elastography and staged as fibrosis stage F0 to F4 and liver steatosis graded S0 to S3. RESULTS: Participants' mean (SD) age was 47.3 (20.9) years. The prevalence of WHtR cut points of 0.40 to <0.50 (normal fat mass), 0.5 to <0.53 (high fat mass), and ≥0.53 (excess fat mass) was 20.3%, 13.6%, and 64.5%. Multivariable-adjusted WHtR high fat mass predicted liver steatosis (odds ratio 1.63 [95% confidence interval 1.16-2.29] P = .005) and fibrosis (1.31 [1.01-1.70] P = .043). Excess WHtR fat mass was associated with liver steatosis (4.02 [2.87-5.64] P < .001) and fibrosis (1.61 [1.03-2.54] P = .038). Normal WHtR fat mass predicted lower odds of liver steatosis (0.52 [0.37-0.73] P < .001) and fibrosis/cirrhosis (0.48 [0.30-0.76] P < .001). WHtR high fat mass and excess fat mass separately predicted higher odds of liver steatosis 1.6-fold and 6-fold, respectively, better than BMI-overweight and BMI-obesity. CONCLUSION: The simple and universally accessible WHtR cut points may be useful in clinical and public health practice for obesity screening, diagnosis, and management.