Evaluation of the Preclinical and Clinical Obesity Framework for Risk Stratification of Major Adverse Liver Outcomes

To evaluate the association between the newly proposed preclinical and clinical obesity framework and the long-term risk of major adverse liver outcomes (MALO).

This retrospective cohort study included 7,462,871 individuals who participated in the 2009-2010 National Health Screening Program. Individuals were divided into three groups: without excess adiposity, preclinical obesity, and clinical obesity. Excess adiposity was determined by body mass index, waist circumference, and waist-to-height ratio. Participants were followed up through December 31, 2023. MALO was defined as hepatocellular carcinoma, liver cirrhosis-related events, and liver-related death, including liver transplantation. Cox proportional hazards regression analysis was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CI).

During a median follow-up of 14.0 years, 105,812 incident cases of MALO were identified. Preclinical obesity and clinical obesity were associated with significantly higher risks of MALO compared to individuals without excess adiposity. The adjusted HRs (95% CI) were 1.08 (1.06-1.10) for preclinical obesity and 1.09 (1.07-1.10) for clinical obesity. When clinical obesity was further stratified, the adjusted HR (95% CI) was 17.64 (16.61-18.73) for clinical obesity with underlying hepatic dysfunction and 1.04 (1.03-1.06) for those without.

The clinical obesity framework offers a clinical approach in predicting long-term liver outcomes. Integrating this framework into clinical and public health practice could reduce the burden of obesity-related liver disease.