Self-Reported Weight Gain After the Age of 20 and Risk of Steatotic Liver Disease

Background/Objectives: We aimed to identify questionnaire items associated with an increased risk of developing hepatic steatosis in the general population. Methods: A total of 15,063 individuals aged ≥20 years who underwent general health checkups and had no hepatic steatosis at baseline were included. The relationship between questionnaire data at baseline and hepatic steatosis incidence over a median 4.2-year follow-up was investigated across body mass index (BMI) categories. Results: Among 15,063 individuals (mean [SD] age, 47.1 [10.2] years; 6769 [44.9%] male; mean [SD] BMI, 21.4 [2.6] kg/m²), 1889 individuals (12.5%) developed hepatic steatosis during follow-up. After adjusting for age, sex, and factors related to metabolic diseases and liver injury, the strongest questionnaire-based risk factor for hepatic steatosis was self-reported weight gain of 10 kg or more after the age of 20 across all BMI categories: total population (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.90-2.34; p < 0.001), Category 1 (BMI < 22) (HR, 2.33; 95% CI, 1.86-2.91; p < 0.001), Category 2 (BMI 22 to <25) (HR, 1.43; 95% CI, 1.25-1.63; p < 0.001), and Category 3 (BMI ≥ 25) (HR, 1.41; 95% CI, 1.12-1.77; p = 0.003). Conclusions: In this cohort study, self-reported weight gain of 10 kg or more after the age of 20 was associated with an increased risk of hepatic steatosis, independent of baseline BMI. Questionnaires capturing weight gain history may support universal screening efforts to identify individuals at elevated risk.