Metabolically obese obese adults had significantly higher odds of advanced liver fibrosis compared to metabolically healthy non-obese adults (OR 167; 95% CI 10.2-2743; p<0.001).
Cross-Sectional (n=349)
Is the metabolically obese obese phenotype associated with increased odds of advanced liver fibrosis compared to the metabolically healthy non-obese phenotype in adults with diabetes?
In adults with diabetes, advanced liver fibrosis on transient elastography is heavily concentrated in those with metabolically unhealthy obesity.
Odds Ratio: 167 (95% CI 10.2–2743)
Absolute Event Rate: 52.9% vs 0%
p-value: p=<0.001
Introduction and Objective: Body mass index (BMI) alone may miss obesity risk; ICMR-INDIAB study supports metabolic phenotyping into four groups based on their metabolic and BMI status: metabolically healthy non-obese (MHNO), metabolically obese non-obese (MONO), metabolically obese obese (MOO), and metabolically healthy obese (MHO). We assessed phenotype distribution and association with liver fibrosis stage using MHNO as a reference. Methods: We conducted a cross-sectional analysis of an adult cohort with complete demographic, anthropometric, and biochemical profiles, all of whom underwent vibration-controlled transient elastography. The participants were categorized into four groups as per the ICMR-INDIAB study. Fibrosis staging was determined via liver stiffness measurement (advanced fibrosis 9.5 kPa). We analyzed the demographic data, sex distribution, and fibrosis staging across categories. Odds ratios (ORs) for advanced fibrosis were calculated using MHNO as the baseline, applying Haldane-Anscombe continuity corrections where necessary. Results: In this cross-sectional cohort of 349 adults (mean age 51.1±11.1 years; 47.3% men), metabolic obesity phenotypes were MHNO n=74 (21.2%), MONO, n=101 (28.9%), MHO, n=2 (0.6%), and MOO, n=172 (49.3%). Advanced fibrosis occurred in 52.9% of participants with MOO (91/172) and in 1/2 with MHO, but in 0/74 with MHNO and 0/101 with MONO. Compared with MHNO, MOO had markedly higher odds of advanced fibrosis (crude OR ∞; Haldane-Anscombe-corrected OR ≈167, 95% CI ≈10.2-2743; p0.001). In fibrosis staging, MHNO and MONO were entirely F0-F1 (7.0 kPa), whereas MOO was predominantly ≥F2 (F2 44.2%, F3 23.8%, F4 31.4%). Conclusion: In this pioneer study with people with diabetes, we found advanced fibrosis on transient elastography was concentrated in metabolically unhealthy obesity, with none observed in non-obesity groups. Combining metabolic risk status with obesity classification may help target fibrosis screening and risk-reduction efforts. Disclosure A. Tewari: None. J. Tewari: None. V. Tewari: None. N. Verma: None. A. Maheshwari: None.
Tewari et al. (2026) conducted a cross-sectional in Diabetes and metabolic obesity (n=349). Metabolically obese obese (MOO) phenotype vs. Metabolically healthy non-obese (MHNO) phenotype was evaluated on Advanced liver fibrosis (> 9.5 kPa) (OR 167, 95% CI 10.2-2743, p=<0.001). Metabolically obese obese adults had significantly higher odds of advanced liver fibrosis compared to metabolically healthy non-obese adults (OR 167; 95% CI 10.2-2743; p<0.001).