Transient elastography assessed hepatic steatosis and fibrosis are associated with body composition in the United States

ABSTRACT Background & Aims We examined transient elastography assessed hepatic steatosis and fibrosis distributions and relationships with body composition in a representative United States population sample. Methods Liver stiffness and controlled attenuation parameter (CAP) were assessed on 4,870 non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and Hispanic men and women aged 20 years and over in the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Participants underwent anthropometry and dual-energy x-ray absorptiometry (DXA). Results Compared to women, men had higher mean CAP (274.2 dB/m vs. 254.4 dB/m) and liver stiffness (6.4 kPa vs. 5.5 kPa). CAP and liver stiffness increased with age and BMI. In multivariate-adjusted analysis, CAP in the upper quartile was associated with increased age, BMI, waist-to-hip ratio, ALT and C-reactive protein (p<0.001 for each). After adjustment, non-Hispanic blacks had lower CAP and non-Hispanic Asians had over twice the odds of higher CAP. In multivariate-adjusted analysis, liver stiffness in the upper quartile was associated with male sex, increased age, BMI, GGT, and CAP (p<0.001 for each), and hepatitis C virus positivity. Lower stiffness among Non-Hispanic Asians was not significant after adjustment for BMI. DXA trunk and extremity fat mass were positively related to both CAP and liver stiffness with adjustment for sex, race-ethnicity, and age (p<0.001 for each). Results were similar with CAP and liver stiffness as continuous characteristics. Conclusion In the U.S. population, increased anthropometric and DXA body composition measures were associated with higher CAP and liver stiffness. Racial-ethnic differences observed merit continuation of NHANES transient elastography to further elucidate the burden of obesity and liver health disparities.