The Metabolic and Hepatic Impact of Central Obesity in MASLD Patients: Evidence from an Iraqi Cross-sectional Cohort

Abstract

Metabolic dysfunction–associated steatotic liver disease (MASLD) represents the redefined spectrum of fatty liver disorders linked to metabolic risk factors such as central obesity, insulin resistance, and dyslipidemia. Central obesity, measured by the waist-to-height ratio (WtHR), has been shown to better predict metabolic and hepatic complications than body mass index (BMI). However, data from Middle Eastern populations, particularly Iraq, remain limited. Objective: To evaluate the metabolic, inflammatory, and hepatic consequences of central obesity among Iraqi patients diagnosed with MASLD. A cross-sectional analytical study was conducted among 120 adult MASLD patients attending tertiary hospitals in Baghdad, Iraq, between September 2024 and June 2025. Participants were divided into two groups based on WtHR: centrally obese (WtHR > 0.5) and non-obese (WtHR < 0.5). Clinical, anthropometric, biochemical, and hepatic parameters were compared using t-tests and chi-square analysis. Logistic regression was applied to identify predictors of central obesity. A p-value < 0.05 was considered statistically significant.

Centrally obese patients were significantly older (46.7 ± 11.3 years) than non-obese patients (39.9 ± 12.4 years; p = 0.003). They exhibited higher mean levels of ALT (49.7 vs 33.1 U/L), AST (46.3 vs 38.0 U/L), fasting glucose (110.3 vs 87.8 mg/dL), triglycerides (235.6 vs 161.1 mg/dL), total cholesterol (253.8 vs 183.4 mg/dL), CRP (19.9 vs 9.7 mg/L), and HOMA-IR (5.93 vs 3.39), all p < 0.05. HDL levels were lower in centrally obese participants (35.1 vs 41.9 mg/dL). FIB-4 index and FibroScan grades were significantly higher, indicating more advanced hepatic fibrosis (p = 0.046). Multivariate regression identified age > 45 years (OR = 2.3, 95% CI 1.3–4.0), physical inactivity (OR = 3.8, 95% CI 2.0–7.2), and unhealthy diet (OR = 4.6, 95% CI 2.1–10.1) as independent predictors of central obesity. Central obesity strongly correlates with metabolic dysregulation, systemic inflammation, and advanced hepatic injury in MASLD. Regular screening using WtHR alongside biochemical markers such as CRP and HOMA-IR can aid early detection and risk stratification in Iraqi clinical settings.