What This Means
This research suggests that among adults with metabolic dysfunction-associated steatotic liver disease (MASLD) — a common liver condition linked to metabolic risk factors — the type of obesity measure used matters when assessing heart failure risk. Using data from nearly 2,800 U.S. adults surveyed between 2017 and early 2020, the researchers found that overall body size as measured by body mass index (BMI) was independently linked to a higher likelihood of having heart failure, even after accounting for conditions like diabetes, high blood pressure, and high cholesterol. However, measures of belly fat specifically — such as waist circumference, waist-to-height ratio, and the body roundness index — were no longer statistically significant predictors of heart failure once those same metabolic conditions were factored in.
This distinction is important because it suggests that in people with MASLD, the connection between abdominal fat and heart failure may be largely explained by the metabolic problems that tend to accompany it, whereas overall body weight (BMI) carries some additional, independent risk. The study also found that the relationships between these body measurements and heart failure appeared to be straight-line (linear), meaning risk increased steadily with higher values rather than jumping sharply at a particular threshold. Additionally, certain subgroups — particularly non-Hispanic Asian individuals and people without diabetes — showed stronger associations between central obesity measures and heart failure, hinting that these relationships may differ across populations.
This research suggests that clinicians managing patients with MASLD may need to consider both general and central obesity measures, but that they should also be aware that the impact of abdominal fat on heart failure risk may be substantially mediated through co-existing metabolic conditions. The cross-sectional design means causality cannot be established, and the reliance on self-reported heart failure diagnosis is a limitation. Nonetheless, these findings highlight the complexity of using anthropometric measures to assess cardiovascular risk in this specific patient population.