{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:57:48Z","timestamp":1792612668055,"version":"4.5.0"},"reference-count":65,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Medical Research Council Transition Award"},{"name":"NUHS Seed Fund","award":["(NUHSRO\/2022\/RO5+6\/Seed-Mar\/03)"],"award-info":[{"award-number":["(NUHSRO\/2022\/RO5+6\/Seed-Mar\/03)"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,8]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although body mass index (BMI)-defined non-obesity metabolic dysfunction-associated steatotic liver disease (MASLD) predicts poor prognosis, the role of visceral adiposity and weight-based phenotypes is unclear. This study aimed to examine the clinical correlates of four unique MASLD phenotypes based on BMI and waist-to-height ratio (WHtR) and to assess the prognostic value of this classification with respect to mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based cross-sectional study with prospective mortality follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationally representative US population derived from the National Health and Nutrition Examination Survey (NHANES), 2007\u20132018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>6300 adults with MASLD, sampled from NHANES 2007 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were allocated into four phenotypes based on obesity\/lean and central adiposity status. Obesity was defined as BMI\u226530\u2009kg\/m\u00b2, while those without obesity were determined as lean. High central adiposity was defined as WHtR\u22650.6.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>The primary outcome was all-cause mortality. This was ascertained through National Death Index linkage with follow-up censored at 31 December 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among adults with MASLD, 72.1% had obesity with high central adiposity (mean follow-up: 6.9\u00b13.5 years). The non-obesity, high central adiposity phenotype (9.6%) exhibited the highest rates of hypertension (60.2%), type 2 diabetes (31.8%) and chronic kidney disease (23.3%). This phenotype portended the poorest 6-year survival (p&lt;0.001) and was independently associated with higher all-cause mortality (adjusted HR (aHR) 3.1, 95%\u2009CI 1.3 to 7.7). A J-shaped association was observed between BMI and mortality, with increasing WHtR linked to elevated risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non-obesity MASLD with high central adiposity confers the poorest survival and cardiometabolic burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113719","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:15:33Z","timestamp":1782404133000},"page":"e113719","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Body weight categories and fat distribution in relation to all-cause mortality among adults with metabolic dysfunction-associated steatotic liver disease: a population-based analysis of NHANES, 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