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Life sciences · Journal article
Journal of the National Medical Association · October 3, 2026
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Background Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non- alcoholic fatty liver disease (NAFLD), is a prevalent liver condition characterized by excessive fat accumulation in hepatocytes, primarily due to metabolic risk factors. Steatosis, the initial accumulation of fat, can progress to liver fibrosis—scarring that impairs liver function—posing significant health risks. While obesity and metabolic syndrome are known contributors, the roles of anthropometric parameters—such as BMI, waist circumference (WC), and waist-to- hip ratio (WHR)—in the development and progression of MASLD, especially in non-diabetic individuals, remain incompletely understood. Objective This study aimed to elucidate the associations between various anthropometric measurements and the presence and severity of hepatic steatosis and fibrosis in adult non-diabetic individuals, with a focus on differentiating between lean and obese phenotypes. Methodology A hybrid cross-sectional and longitudinal cohort design was employed, involving adult participants without diabetes. Anthropometric evaluations—including BMI, WC, WHR, and others—were collected alongside laboratory and imaging data to diagnose and assess the severity of MASLD, specifically evaluating degrees of steatosis and fibrosis. The relationships between these parameters and disease occurrence and progression over time were analyzed. Results Findings revealed that central obesity metrics, especially WC and WHR, were significantly associated with the presence and severity of hepatic steatosis and fibrosis. Participants with elevated WC and WHR—regardless of overall BMI—had a higher likelihood of developing MASLD and exhibited more advanced steatosis and fibrosis stages over time. Notably, lean individuals with central adiposity also demonstrated increased risk and disease progression. Discussion These results underscore the critical role of fat distribution, particularly central adiposity, in the development and progression of hepatic steatosis and fibrosis within MASLD in non-diabetic adults. Incorporating routine anthropometric measurements like WC and WHR into clinical assessments can improve risk stratification and early detection. Overall, the study