DXA-Derived Body Composition Phenotypes in Men with Chronic Hepatitis C

Background: Chronic hepatitis C (CHC) is associated with persistent inflammation, metabolic dysfunction, and body composition abnormalities that extend beyond liver disease. However, the coexistence of reduced muscle mass, occult obesity, and altered fat distribution remains poorly characterized. This study evaluated DXA-derived body composition phenotypes in men with CHC and their associations with inflammatory markers, liver fibrosis, and lifestyle factors. Methods: In this retrospective cross-sectional study, 70 men with CHC and 70 age-, sex-, and BMI-matched healthy controls underwent whole-body dual-energy X-ray absorptiometry (DXA). Appendicular lean mass index (ALMI), total and regional fat mass, body fat percentage, and fat distribution were assessed. Associations with inflammatory markers, liver fibrosis, and lifestyle factors were analyzed using non-parametric tests, ROC analysis, and multivariable logistic regression. Results: Patients with CHC had significantly lower ALMI, total limb lean mass, trunk fat mass, body fat percentage, and android/gynoid fat ratio than controls. Low muscle mass was present in 24.3% of patients, while 48.6% met DXA criteria for obesity, including 12.9% with occult obesity and 20.0% with BMI–BFP discordance. Overall, 61.4% exhibited abnormal body composition phenotypes. Low muscle mass was associated with higher erythrocyte sedimentation rate, fibrinogen, neutrophil and leukocyte counts, and more advanced liver fibrosis. Conclusions: Men with CHC frequently exhibit reduced muscle mass, altered fat distribution, occult obesity, and obesity with low muscle mass that are not reliably detected by BMI. DXA-based body composition assessment may improve identification of high-risk metabolic phenotypes and support individualized management.