{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:05:16Z","timestamp":1790057116962,"version":"4.0.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018568","name":"Special Fund Project for Science and Technology Innovation Strategy of Guangdong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018568","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>According to the 2025 international consensus published in The Lancet Diabetes &amp;amp; Endocrinology, obesity can be conceptualized as a progressive disease with two stages: preclinical obesity, characterized by excess adiposity without established organ dysfunction, and clinical obesity, defined by the presence of obesity-related organ damage. However, determinants of the transition from preclinical to clinical obesity remain poorly understood. Fatty liver, a common manifestation of metabolic dysfunction, may represent an early indicator of this progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 18,955 adults with preclinical obesity but without clinical obesity at baseline from the Kailuan Study. Fatty liver was diagnosed by abdominal ultrasound and categorized as mild or moderate-to-severe. Clinical obesity was defined as the development of at least one obesity-related organ dysfunction during follow-up. Weighted Cox regression was used to estimate the average association between baseline fatty liver and incident clinical obesity after multivariable adjustment, while extend Cox models with time-varying coefficients were used to evaluate changes in the association over follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow-up of 7.8 years, 11,463 participants developed clinical obesity. Ultrasound-defined fatty liver was independently associated with an increased risk of progression to clinical obesity (fully adjusted HR: 1.59, 95% CI: 1.50\u20131.68), with a severity-dependent gradient (mild: HR 1.55, 95% CI: 1.45\u20131.65; moderate-to-severe: HR 1.70, 95% CI: 1.59\u20131.82). Women with moderate-to-severe fatty liver had the highest risk (HR: 1.77, 95% CI: 1.56\u20132.01). Results were consistent in sensitivity analyses. Hypertension, obstructive sleep apnea syndrome, and hyperglycemia-dyslipidemia syndrome were the most common organ dysfunctions contributing to clinical obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ultrasound-defined fatty liver is associated with a significantly increased risk of progressing from preclinical to clinical obesity. These findings suggest that ultrasound-defined fatty liver may help identify individuals with preclinical obesity who are at increased risk of progressing to clinical obesity and may support targeted metabolic surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1877518","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:39:21Z","timestamp":1790055561000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-defined fatty liver and the risk of progression from preclinical to clinical obesity: a prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Haixiang","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]},{"name":"Department of Biomedical Sciences, University of 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