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Epidemiology and Population Health

A U-shaped relationship between body mass index and the risk of elevated liver stiffness in older people: evidence from the 5‐year retrospective cohort study

International Journal of Obesity volume 49, pages 2110–2116 (2025)Cite this article

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Abstract

Background

The relationship between body mass index (BMI) and liver stiffness in older people remains unclear. This study aimed to examine the association between BMI and the risk of elevated liver stiffness in older people.

Methods

2736 participants from the West China Health and Aging Cohort Study (WCHAC) were included in the present study. Liver stiffness was assessed using transient elastography (TE). The association of the 5-year average BMI level with elevated liver stiffness risk was estimated using multinomial logistic regression. The group-based trajectory model (GBTM) was applied to identify BMI trajectories. Additionally, restricted cubic spline analysis was conducted to explore the dose-response association between BMI and the risk of elevated liver stiffness.

Results

Participants in the second BMI quartile (21.93–23.58) had the lowest prevalence of elevated liver stiffness, and then the risk increased with higher BMI quartiles (BMI Q4 vs. Q2, OR = 2.05, 95% CI: 1.37–3.11 and Q5 vs. Q2, OR = 2.82, 95% CI: 1.78–4.39). There were five BMI trajectories over the five-year period: low-normal-weight stable (7.42%), moderate-normal-weight stable (29.10%), low-level-overweight stable (36.22%), high-level-overweight stable (20.32%) and stable obesity (6.94%). Participants in the moderate-normal-weight stable group had the lowest prevalence of elevated liver stiffness. Compared with this group, the adjusted ORs (95% CI) elevated liver stiffness prevalence were 2.02 (1.39–2.97) for the high-level-overweight stable, and 2.83 (1.72–4.64) for the group of people with stable obesity. Dose-response analysis revealed a U-shaped relationship between BMI and elevated liver stiffness risk, suggesting an optimal BMI range of 21.8–24.3 kg/m² for older people to minimize elevated liver stiffness risk.

Conclusions

Our study elucidated the U-shaped relationship between BMI and the risk of elevated liver stiffness as measured by TE, and the optimal BMI range from 21.8 to 24.3 kg/m2 for the lowest risk of elevated liver stiffness in older people.

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Fig. 1: The trajectory of BMI during 2017–2022.
Fig. 2: Box plot of BMI changes during 2017–2022.
Fig. 3: Dose-response association between 5-year average BMI level and the risk of elevated liver stiffness.

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Data availability

The dataset that supports this article is from the WCHAC project. Data sharing requires approval, and further details on how to request the datasets can be provided upon inquiry. The full analysis code is available from the corresponding author.

Code availability

The dataset that supports this article is from the WCHAC project. Data sharing requires approval, and further details on how to request the datasets can be provided upon inquiry. The full analysis code is available from the corresponding author.

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Acknowledgements

All authors involved in this study extend their gratitude to the staff of the West China Health and Aging Cohort research team for their dedicated work. We would also like to express our sincere appreciation to Shenzhen Huibo Medical Equipment Co., Ltd. for providing the FibroScan equipment, which was instrumental in conducting liver stiffness measurements and crucial to the success of our study.

Funding

This study was supported by funds from National Key R&D Program of China (2020YFC2006505).

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Author notes

  1. These authors contributed equally: Liang Lv, Lu Long

Authors and Affiliations

  1. West China Institute of Preventive and Medical Integration for Major Diseases, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

    Liang Lv, Lu Long, Yue Zheng, Nan Yang, Jinyu Xiao, Tianpei Ma, Xin Chen, Xinyang Dui, Xiaoxue Liu, Tao Zhang, Juan Liao & Jiayuan Li

  2. West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China

    Liang Lv, Lu Long, Yue Zheng, Nan Yang, Jinyu Xiao, Tianpei Ma, Xin Chen, Xinyang Dui, Xiaoxue Liu, Tao Zhang, Juan Liao & Jiayuan Li

  3. Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

    Liang Lv, Lu Long, Nan Yang, Jinyu Xiao, Tianpei Ma, Xin Chen, Xinyang Dui, Xiaoxue Liu, Tao Zhang & Jiayuan Li

  4. Department of Gastroenterology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

    Yue Zheng & Juan Liao

  5. Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China

    Huan Zhou

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Contributions

LLv, LLong, JLi, and JLiao contributed to the study design, data analysis, interpretation, and drafting of the manuscript. YZ, NY, JX, TM, XC, XD, XL, TZ, and HZ contributed to the acquisition of data and critical revision of the manuscript for important intellectual content. JLiao and JLi supervised the study. All authors read and approved the final manuscript.

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Correspondence to Juan Liao or Jiayuan Li.

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Lv, L., Long, L., Zheng, Y. et al. A U-shaped relationship between body mass index and the risk of elevated liver stiffness in older people: evidence from the 5‐year retrospective cohort study. Int J Obes 49, 2110–2116 (2025). https://doi.org/10.1038/s41366-025-01849-8

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