Sex- and reproductive status-specific relationships between body composition and non-alcoholic fatty liver disease

Background: Gender and reproductive status differences exist in both non-alcoholic fatty liver disease (NAFLD) and body composition. Our purpose was to investigate the relationship between body composition and the severity of liver steatosis and fibrosis in NAFLD in different gender and reproductive status populations. Methods: This cross-sectional study included 880 participants (355 men, 417 pre-menopausal women, 108 post-menopausal women). Liver steatosis and fibrosis and body composition data were measured using FibroScan and a bioelectrical impedance body composition analyzer (BIA), respectively. Multiple ordinal logistic regression (MOLR) was used to analyze the correlation between body composition indicators and liver steatosis grade and fibrosis stage in different gender and menopausal status populations. Results: Men have higher waist circumference (WC), appendicular skeletal muscle mass (ASM), appendicular skeletal muscle mass index (ASMI), fat free mass (FFM), and fat free mass to fat mass ratio (FFM/FM) than pre- or post-menopausal women, while pre-menopausal women have higher percent body fat (PBF), visceral fat area (VFA), and fat mass (FM) than the other two groups (p < 0.001). Besides, men have greater controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) values (p < 0.001). For MOLR, after adjusting for confounding factors, WC (OR, 1.07; 95% CI, 1.02-1.12; P = 0.011) and FFM/FM (OR, 0.52; 95% CI, 0.31-0.89; P = 0.017) in men and visceral obesity (OR, 4.16; 95% CI, 1.09-15.90; P = 0.037) in post-menopausal women are independently associated with liver steatosis grade. WC, PBF, and visceral obesity are independently associated with liver fibrosis stage in men (OR, 1.05; 95% CI, 1.01-1.09, P = 0.013; OR, 1.08; 95% CI, 1.01-1.15; P = 0.018; OR, 3.92; 95% CI, 1.97-7.81; P < 0.001, respectively). Conclusions: Increased WC and low FFM/FM in men and visceral obesity in post-menopausal women are independent correlates of aggravated liver steatosis. In addition, increased WC, PBF, and visceral obesity are independent correlates of worsening liver fibrosis in men. These data support the gender- and reproductive status-specific management of NAFLD.