New Obesity Definitions Reclassify Many MASLD Patients but Do Not Improve Liver Risk Prediction

New obesity definitions from EASO and the Lancet Commission reclassified 20.4% and 34.1% of MASLD patients as obese who were non-obese by BMI alone.
These newly classified obese groups did not have a significantly higher risk of liver-related events compared with non-obese patients (adjusted SHR 1.15 and 0.75, respectively).
Risk of liver-related events increased meaningfully only when waist-to-height ratio approached 0.6, suggesting higher thresholds may be needed.
BMI alone remains a comparable predictor of liver outcomes in MASLD, and new definitions broaden the obesity population without improving risk stratification.

Study Snapshot

Design: Multinational cohort study using the VCTE-Prognosis cohort.
Population: 12,583 patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
Exposure: Obesity defined by three frameworks: BMI alone, EASO criteria (BMI obesity or overweight with WHtR ≥0.5 plus comorbidity), and Lancet Commission criteria (BMI obesity plus ≥1 elevated anthropometric measure, or ≥2 elevated measures, or BMI ≥40 kg/m²).
Primary Outcome: Liver-related events (LRE) incidence per 1,000 person-years.
Key Result: LRE incidence was 2.4 (normal weight), 3.4 (overweight), 5.2 (obese) per 1,000 person-years by BMI. New definitions did not improve LRE prediction (aSHR 1.15 for EASO reclassified; 0.75 for Lancet reclassified).

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

New obesity definitions from EASO and the Lancet Commission reclassified 20.4% and 34.1% of MASLD patients as obese who were non-obese by BMI alone.
These newly classified obese groups did not have a significantly higher risk of liver-related events compared with non-obese patients (adjusted SHR 1.15 and 0.75, respectively).
Risk of liver-related events increased meaningfully only when waist-to-height ratio approached 0.6, suggesting higher thresholds may be needed.
BMI alone remains a comparable predictor of liver outcomes in MASLD, and new definitions broaden the obesity population without improving risk stratification.

Study Snapshot

Design: Multinational cohort study using the VCTE-Prognosis cohort.
Population: 12,583 patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
Exposure: Obesity defined by three frameworks: BMI alone, EASO criteria (BMI obesity or overweight with WHtR ≥0.5 plus comorbidity), and Lancet Commission criteria (BMI obesity plus ≥1 elevated anthropometric measure, or ≥2 elevated measures, or BMI ≥40 kg/m²).
Primary Outcome: Liver-related events (LRE) incidence per 1,000 person-years.
Key Result: LRE incidence was 2.4 (normal weight), 3.4 (overweight), 5.2 (obese) per 1,000 person-years by BMI. New definitions did not improve LRE prediction (aSHR 1.15 for EASO reclassified; 0.75 for Lancet reclassified).

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