Association of general obesity, metabolically healthy obesity, and abdominal adiposity markers with elevated liver enzymes: a population-based study

The effects of metabolically healthy obesity and abdominal adiposity on liver enzymes remain unclear. This study was a population-based cross-sectional analysis that was conducted among 10,009 adults aged 35-70 years in southwest Iran between 2016 and 2018. Clinical data, including liver enzyme levels (ALT, AST, ALP, and GGT), anthropometric indices (waist circumference, waist-to-hip ratio, BMI), lifestyle factors (physical activity, smoking), laboratory measures (triglycerides, HDL, cholesterol, FBS), and sociodemographic factors (wealth status, residence type, education level) were collected. Multiple logistic regression analyses were used to assess associations. The findings showed that the prevalence of liver enzyme abnormalities was 35.8% (95% CI: 34.9-36.8) among the participants enrolled in the Hoveyzeh cohort study. Elevated liver enzymes were significantly more common in individuals with obesity, abnormal waist circumference (WC), increased waist-to-hip ratio (WHR), metabolically unhealthy obesity, dyslipidemia, metabolic syndrome, hypertension, diabetes, and physical inactivity. Based on multiple logistic regression analyses, the odds of liver enzyme abnormalities were 36% higher in individuals with obesity (Odds Ratio [OR] = 1.36, 95% CI: 1.25-1.48), 48% higher in those with abnormal WC (OR = 1.48, 95% CI: 1.33-1.65), 75% higher in those with metabolically unhealthy obesity (OR = 1.75, 95% CI: 1.60-1.90), and more than twofold higher in those with elevated WHR (OR = 2.26, 95% CI: 1.92-2.66). Overall, all three forms of obesity (general, abdominal, and phenotypic) were associated with elevated liver enzymes. Strategies targeting obesity and metabolic health may help prevent liver dysfunction in this population.