2600-P: Waist-to-Height Ratio Outperforms BMI in Identifying Hepatic Steatosis and Fibrosis in U.S. Adults

Introduction and Objective: Hepatic steatosis is highly prevalent yet frequently undiagnosed, despite strong associations with cardiometabolic disease and liver fibrosis. Body mass index (BMI) is widely used but inadequately reflects ectopic and visceral adiposity, which are more closely linked to cardiometabolic disease. We compared BMI with waist-based anthropometric measures to identify hepatic steatosis and increased liver stiffness at clinically relevant thresholds. Methods: We conducted a cross-sectional analysis of adults aged ≥18 years from NHANES 2021-2023, excluding pregnancy, heavy alcohol use, and viral hepatitis. Measures included BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Hepatic steatosis and liver stiffness were assessed using transient elastography, defining moderate to severe hepatic steatosis as controlled attenuation parameter (CAP) >260 dB/m and advanced fibrosis as liver stiffness measurement (LSM) ≥8 kPa. NHANES-weighted receiver operating characteristic analyses estimated weighted area under the curve (WAUC), and high-risk categories were evaluated using weighted regression models. Results: Among 3,905 participants (mean age 47 years; 50% female), CAP >260 dB/m was present in 46.5% and LSM ≥8 kPa in 10.9%. WHtR and WC demonstrated greater discrimination than BMI for hepatic steatosis (WAUC 0.82-0.83 vs 0.81) and increased liver stiffness (WAUC 0.76 vs 0.74), while WHR performed less well. At high-risk thresholds, elevated WHtR was associated with markedly higher prevalence of hepatic steatosis (PR 10.45; 95% CI 6.74-16.22) and increased liver stiffness (PR 3.92; 95% CI 2.36-6.51). Conclusion: WHtR, a simple measure of central adiposity, outperforms BMI for identifying individuals at high risk for hepatic steatosis and liver fibrosis. Incorporating waist-based measures into routine assessment may improve detection of cardiometabolic disease and support pragmatic risk stratification in clinical and population settings. Disclosure S. Jang: None. D.K. Ernest: None. A. Herrera Chancay: None. L. Xie: None. J.M. Francis: None. M.S. Mathew: None. S.E. Messiah: None. J. Almandoz: Consultant; Current; AbbVie Inc., Amgen Inc., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Kailera, Novo Nordisk, Metsera, Rhythm Pharmaceuticals, Inc., Rivus.