Discordance between adiposity and FIB-4 risk classification in US adults

Area of Science:

• Hepatology and Gastroenterology
• Metabolic Health and Obesity
• Public Health and Epidemiology

Background:

• The Fibrosis-4 (FIB-4) index is a key noninvasive marker for liver fibrosis risk stratification.
• The interplay between adiposity metrics and FIB-4 classification requires further elucidation.

Purpose of the Study:

• To investigate the association between various adiposity measures and FIB-4 risk classification in a U.S. adult population.
• To determine if age influences the relationship between adiposity and FIB-4 risk.

Main Methods:

• Analysis of data from 10,711 U.S. adults (aged 35-65) from NHANES (2011-2018).
• Evaluation of anthropometric measures: BMI, total body fat percentage, waist circumference, and waist-to-hip ratio.
• Logistic regression models used to assess associations, with interaction analyses stratified by age group.

Main Results:

• A majority of participants had low-risk FIB-4 scores (72.9%).
• Higher BMI, total body fat percentage, and waist circumference were associated with lower FIB-4 risk classification.
• In adults aged 51-65, increased BMI and body fat were inversely associated with high-risk FIB-4 scores, unlike in younger adults.

Conclusions:

• Increased adiposity is paradoxically associated with a reduced likelihood of high-risk FIB-4 classification.
• Age-specific differences in the adiposity-FIB-4 association highlight potential discordance in risk assessment.
• Tailored, age- and adiposity-informed strategies are needed for accurate hepatic fibrosis risk assessment.