Search Results (1,156)

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with ectopic fat accumulation and alterations in adipose tissue function. However, the relationships of structural and thermogenic adipose imaging markers with hepatic steatosis remain incompletely understood. This study aimed to jointly evaluate the cross-sectional associations of epicardial adipose tissue (EAT) thickness and infrared thermography (IRT)-derived brown adipose tissue (BAT)-related thermogenic activity with controlled attenuation parameter (CAP)-defined hepatic steatosis severity in adults with suspected MASLD. Methods: In this cross-sectional study, 207 adults undergoing clinical evaluation for suspected MASLD underwent transient elastography to obtain the controlled attenuation parameter (CAP) for hepatic steatosis assessment. EAT thickness was measured by transthoracic echocardiography, and BAT-related thermogenic activity was assessed by infrared thermography using the supraclavicular-to-chest temperature difference (ΔTemp). Associations of these adipose imaging phenotypes with CAP were evaluated using correlation analyses, sequential multivariable linear regression models, and BAT-stratified analyses. Results: EAT thickness increased progressively across CAP-defined steatosis grades (p < 0.001) and was positively correlated with CAP (r = 0.637, p < 0.001), whereas ΔTemp decreased with increasing steatosis severity and was inversely correlated with CAP (ρ = −0.277, p < 0.001). In sequential multivariable regression models, EAT thickness remained independently associated with CAP across adjustments for age, sex, body mass index, metabolic variables, and ΔTemp (standardized β = 0.559–0.623; all p < 0.001). Both EAT thickness and ΔTemp were independently associated with CAP in the fully adjusted model, with a stronger association for EAT thickness (standardized β = 0.559 vs. −0.167; p < 0.001 and p = 0.004, respectively). Stratified analyses demonstrated consistent associations between EAT thickness and CAP across both BAT-low and BAT-high activity groups. Conclusions: Greater EAT thickness and lower IRT-derived ΔTemp were independently associated with greater CAP-defined hepatic steatosis severity, with EAT thickness showing the stronger standardized association. These complementary structural and thermogenic imaging correlates warrant prospective evaluation to clarify their directionality and clinical relevance. Full article

Background/Objectives: Adults at high risk of type 2 diabetes frequently show concurrent dyslipidemia, insulin resistance, and central adiposity before overt diabetes develops. We evaluated cardiometabolic responses to standardized whole-grain staple replacement and examined grain-quality patterns in free-living and country-level settings. Methods: This secondary exploratory analysis included 144 participants (48 per group) from a 12-week, three-arm randomized dietary trial. Participants were analyzed according to their randomized assignments to 100 g/day, 50 g/day, or control. Lipid, anthropometric, body composition, and composite cardiometabolic phenotypes were evaluated. Longitudinal and time-weighted cumulative effects were estimated using linear mixed-effects and regression models, with Benjamini–Hochberg false discovery rate (FDR) correction applied within the corresponding multiplicity domains. Complementary analyses included 30,769 NHANES adults without diabetes, including 12,169 with prediabetes, and descriptive country-level data on whole-grain intake, high-FPG-attributable diabetes burden, and cereal supply. Results: Within the extended phenotype panel, HWG versus control time-weighted cumulative effects included triglycerides (β = −0.220, 95% CI −0.397 to −0.043; FDR-adjusted p = 0.047), the atherogenic index of plasma (β = −0.125, −0.191 to −0.060; FDR-adjusted p = 0.002), and the triglyceride–glucose index (β = −0.301, −0.429 to −0.173; FDR-adjusted p < 0.001). Conventional lipid components showed distinct temporal responses. In NHANES, higher whole-grain exposure and more favorable grain-quality ratios were associated with lower adiposity- and insulin resistance-related phenotypes, whereas refined-grain exposure generally showed the opposite pattern. Country-level analyses showed marked heterogeneity in whole-grain intake, diabetes burden, and cereal supply context. Conclusions: Standardized whole-grain staple replacement was associated with short-term changes across several cardiometabolic dimensions in adults at high risk of type 2 diabetes, with the clearest extended-phenotype signals involving triglyceride-related and glucose–triglyceride coupling measures. NHANES identified cross-sectional grain-quality associations in free-living adults; country-level analyses described heterogeneity in whole-grain intake, diabetes burden, and cereal supply context. Full article

Background/Objectives: Postmenopausal aging is accompanied by progressive loss of skeletal muscle mass and increased abdominal adiposity, both of which may influence bone health through distinct mechanical and metabolic pathways. However, their independent associations with bone mineral density (BMD) at different skeletal sites remain incompletely characterized. This study investigated the independent associations of appendicular skeletal muscle mass index (ASMI) and waist circumference (WC) with site-specific BMD in postmenopausal women. Methods: This cross-sectional study included 345 postmenopausal women who attended a university hospital menopause clinic in Thailand. Body composition was assessed using multi-frequency bioelectrical impedance analysis, and ASMI was calculated according to the Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria. WC was measured using standardized anthropometric procedures. BMD at the lumbar spine (L1–L4), total hip, and femoral neck was determined by dual-energy X-ray absorptiometry. Multivariable linear regression analyses were performed to evaluate the independent associations of ASMI and WC with site-specific BMD after adjustment for age, years since menopause, hormone replacement therapy use, osteoporosis medication use, calcium supplementation, vitamin D supplementation, and fracture history. Robust standard errors were used in the final models. Results: Higher ASMI was independently associated with higher BMD at the lumbar spine (standardized β = 0.362, p < 0.001), total hip (standardized β = 0.371, p < 0.001), and femoral neck (standardized β = 0.353, p < 0.001). WC was positively associated with total hip BMD (standardized β = 0.158, p = 0.006), whereas no statistically significant associations were observed at the lumbar spine (standardized β = 0.009, p = 0.899) or femoral neck (standardized β = 0.105, p = 0.092). Conclusions: ASMI was consistently associated with BMD across all measured skeletal sites, whereas the association between WC and BMD varied according to skeletal region. These findings support the complementary assessment of skeletal muscle mass and central adiposity for characterizing body composition and skeletal health in postmenopausal women. Full article

Background: Composite anthropometric and cardiometabolic indices have emerged as practical tools for identifying metabolic syndrome (MetS), but their comparative classification performance against ALAD-defined MetS has not been comprehensively evaluated in Panamanian adults. This study compared the classification performance of selected anthropometric, body composition, and cardiometabolic indices for identifying metabolic syndrome defined according to the Latin American Diabetes Association (Asociación Latinoamericana de Diabetes [ALAD]) criteria in non-diabetic Panamanian adults. Methods: This cross-sectional study included 262 adults without diabetes (110 men and 152 women). Clinical and laboratory measurements were used to calculate the body mass index (BMI), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic index of plasma (AIP), cardiometabolic index (CMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Classification performance was evaluated using receiver operating characteristic (ROC) curve analysis, optimal cut-off values, and DeLong’s test. Age-adjusted logistic regression assessed associations between each index and ALAD-defined MetS. Results: Composite indices integrating anthropometric and metabolic parameters showed high classification performance. CMI had the highest observed AUC in men (AUC = 0.933; 95% CI: 0.887–0.979), whereas LAP had the highest observed AUC in women (AUC = 0.854; 95% CI: 0.778–0.931). Conclusions: CMI and LAP showed high classification performance for identifying ALAD-defined MetS in Panamanian adults without diabetes, with the highest observed AUCs in men and women, respectively. These simple, inexpensive indices may have potential utility as screening tools for identifying ALAD-defined MetS in primary healthcare settings. The proposed cut-off values are exploratory and require external validation in independent Panamanian and Latin American populations before clinical implementation. Full article

Shoulder pain ranks among the leading causes of functional decline in older adults, affecting approximately one in five community-dwelling individuals and contributing to loss of independence and reduced quality of life. Despite its prevalence, shoulder pain in this population is frequently underreported and poorly understood beyond structural pathology, limiting early identification and targeted intervention. This narrative review synthesizes current evidence on the associations between four interrelated physical domains, body composition, grip and shoulder muscle strength, cervical–shoulder range of motion (ROM), and postural alignment, with particular emphasis on forward head posture and shoulder pain and disability in community-dwelling adults aged 60 years and older. A structured search of major electronic databases, including PubMed and Web of Science, was conducted using predefined eligibility criteria and keyword combinations linking shoulder pain and disability with each physical domain. Additional primary studies were identified through manual reference screening of key articles and citation tracking. Evidence was synthesized thematically, highlighting patterns of association, methodological inconsistencies, and contradictions across studies. Findings indicate that higher adiposity, reduced lean mass, shoulder and grip strength deficits, restricted glenohumeral and cervical ROM, and postural deviations are each associated with greater shoulder pain and disability. However, the evidence is not uniformly consistent: associations between Body Mass Index and shoulder ROM are largely absent at moderate adiposity levels, resting postural deviation does not reliably distinguish individuals with shoulder pain from those without, and the causal direction between strength deficits and postural deterioration remains debated. Despite these contradictions, emerging evidence suggests that these domains may interact with one another, and the literature collectively supports an integrated, multifactor assessment framework over single-variable approaches for the evaluation and management of shoulder dysfunction in community-dwelling older adults. Evidence quality was not formally assessed, and evidence for forward head posture specifically in older adults remains limited and largely indirect, drawn mainly from younger populations. Full article

Background: Hypertension is a major public health challenge and a leading contributor to cardiovascular morbidity and mortality worldwide. Although obesity is a well-established risk factor for hypertension, the body composition characteristics most strongly associated with hypertension remain unclear. This study aimed to investigate the associations between body composition parameters and hypertension among Thai adults. Methods: This case–control study included 208 Thai adults aged ≥18 years, comprising 103 normotensive individuals and 105 individuals with hypertension. Blood pressure indices included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), and rate-pressure product (RPP). Body composition was assessed using bioelectrical impedance analysis (BIA) and included overall and regional body composition parameters, including visceral fat level, fat mass, body fat percentage, and skeletal muscle mass. Differences between groups were examined, and multivariable logistic regression analyses were performed to identify factors independently associated with hypertension. Results: Compared with normotensive participants, individuals with hypertension were significantly older (p < 0.001) and more likely to be male (p = 0.010). They also exhibited significantly greater adiposity-related characteristics, including higher body weight (p = 0.001), body mass index (p = 0.001), body fat percentage (p = 0.023), fat mass (p < 0.001), visceral fat level (p < 0.001), and waist-to-hip ratio (p = 0.037), together with higher SBP, DBP, PP, MAP, and RPP (all p < 0.001). In Model 3, older age (OR = 1.06, 95% CI: 1.04–1.09; p < 0.001), male sex (OR = 5.35, 95% CI: 1.69–16.95; p = 0.004), and higher visceral fat level (OR = 1.16, 95% CI: 1.06–1.26; p < 0.001) were associated with hypertension, whereas skeletal muscle mass was not (OR = 1.03, 95% CI: 0.95–1.12; p = 0.438). Each one-unit increase in visceral fat level was associated with a 16% increase in the odds of hypertension. The final model demonstrated acceptable discrimination (AUC = 0.79, 95% CI: 0.72–0.85). Conclusions: A higher BIA-derived visceral fat level was associated with hypertension among Thai adults after adjustment for age, sex, and skeletal muscle mass, whereas skeletal muscle mass showed no independent association in the same model. These findings suggest that visceral fat distribution may provide complementary information in cardiometabolic assessment. However, prospective studies using imaging-based assessments are required to confirm these findings. Full article

Background: Vaspin (SERPINA12) is an adipokine implicated in the regulation of insulin sensitivity and metabolic homeostasis. Evidence regarding its association with obesity-related metabolic disturbances remains inconsistent, and potential sex-specific differences are not fully understood. Methods: This cross-sectional study included 81 adults aged 30–60 years (38 women and 43 men), divided into a metabolic syndrome group (MS+) and a control group (MS−). Anthropometric, biochemical, total antioxidant status and blood pressure parameters were assessed, and insulin resistance was estimated using the HOMA-IR index. Results: In MS+ men, serum vaspin concentrations were higher than in MS− men (p = 0.004) and were associated with BMI, waist circumference, body fat percentage, fasting insulin, HOMA-IR, and diastolic blood pressure (p < 0.05 for all). In multivariable regression analysis (adjusted for age), insulin levels, lean body mass, and diastolic blood pressure explained up to 15.2% of the variability in serum vaspin concentrations in men (p = 0.035), whereas no significant model was observed in women. ROC (receiver operating characteristic) curve analysis demonstrated better discriminative performance of serum vaspin for identifying metabolic syndrome in men than in women (AUC: 0.784 ± 0.094 vs. 0.416 ± 0.115, respectively; p = 0.013). Conclusions: Circulating vaspin concentrations are more strongly associated with metabolic disturbances in men than in women These findings suggest that sex-specific regulation of vaspin may contribute to differences in metabolic dysfunction associated with visceral obesity. Overall, these results indicate that vaspin may reflect visceral obesity-related metabolic dysfunction rather than general adiposity. Further studies are needed to clarify the mechanistic role of vaspin and to determine whether it has potential as a biomarker of metabolic dysfunction. Full article

Background: Computed tomography (CT)-derived body composition has emerged as a promising prognostic biomarker in pancreatic ductal adenocarcinoma (PDAC). However, most previous studies have relied on baseline measurements and evaluated either resected or metastatic disease separately. We aimed to investigate the prognostic significance of both baseline and longitudinal CT-derived body composition changes in clinically distinct but therapeutically homogeneous cohorts of patients with PDAC receiving FOLFIRINOX. Methods: This retrospective single-center study included 98 consecutive patients with histologically confirmed PDAC treated with FOLFIRINOX between 2018 and 2025. Forty-seven patients underwent curative-intent resection followed by adjuvant modified FOLFIRINOX, whereas 51 patients with unresectable metastatic disease received first-line FOLFIRINOX. Skeletal muscle index (SMI) and visceral adipose tissue (VAT) were quantified on serial CT scans obtained at the third lumbar vertebral level before treatment and during therapy. Follow-up CT scans suitable for longitudinal body composition analysis were available for 46 of 51 patients (90.2%) in the metastatic cohort. Overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify independent prognostic factors. Results: Baseline CT-derived body composition parameters were not independently associated with survival in either cohort. In the resected cohort, preservation of visceral adiposity during treatment (follow-up VAT > 100 cm²) independently predicted improved OS in a multivariable model including three covariates (HR 0.460, 95% CI 0.220–0.960; p = 0.039). Median DFS and OS were 11.7 months (95% CI 6.5–16.9) and 20.9 months (95% CI 12.1–29.7), respectively. In the metastatic cohort, treatment-related skeletal muscle loss (ΔSMI) independently predicted inferior OS in a multivariable model including four covariates (HR 0.949, 95% CI 0.913–0.986; p = 0.008), while lung metastasis was also independently associated with worse survival (HR 5.792, 95% CI 1.880–17.841; p = 0.002). Median PFS and OS were 9.7 months (95% CI 8.0–11.4) and 12.7 months (95% CI 9.9–15.5), respectively. Conclusions: Longitudinal CT-derived body composition changes may provide additional prognostic information beyond baseline measurements in patients with PDAC receiving FOLFIRINOX. Preservation of visceral adiposity was associated with improved survival following curative-intent resection, whereas greater treatment-related skeletal muscle loss was associated with poorer survival in metastatic disease. These findings suggest that the prognostic relevance of body composition may vary according to disease stage and should be considered hypothesis-generating pending validation in larger prospective multicenter studies. Full article

Background: Body mass index (BMI) is widely used to assess pediatric obesity but has limitations in distinguishing between fat and muscle mass. This study aimed to investigate the association between various body composition parameters and insulin resistance (IR) and to evaluate their clinical utility in prepubertal children with obesity. Methods: This retrospective cross-sectional study evaluated prepubertal children with obesity. Anthropometric measures and body composition, including percent body fat (PBF) and fat-to-muscle ratio (FMR), were assessed using bioelectrical impedance analysis. IR was defined as a homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5. Spearman rank correlation, linear regression, and multivariate logistic regression analysis were performed to identify independent associated factors for IR. Results: A total of 147 prepubertal children (61 males, 86 females) were analyzed. The IR group exhibited significantly higher waist circumference SDS (WC_SDS), waist circumference-to-height ratio SDS (WHtR_SDS), and FMR compared to the non-IR group (all p < 0.05). In correlation analysis, HOMA-IR showed significant positive associations with WC_SDS (ρ = 0.39) and FMR (ρ = 0.22). After adjusting for age and sex, WC SDS (odds ratio (OR) = 6.04; 95% CI: 2.47–14.75; p < 0.001), FMR (OR = 4.41; 95% CI: 1.16–16.78; p = 0.030), BMI SDS (OR = 2.31; 95% CI: 1.30–4.10; p = 0.004), and PBF (OR = 1.12; 95% CI: 1.04–1.20; p = 0.004) remained independent risk factors for IR. Conclusions: In prepubertal children with obesity, WC SDS, FMR, BMI SDS and PBF were each significantly associated with IR after adjusting for age and sex. These findings suggest that measures of central adiposity and fat-to-muscle balance, in addition to conventional weight-based indices, are relevant to metabolic risk assessment in this age group. Full article

Background: Hedonic hunger and problematic internet use (PIU) have been linked to excess adiposity, but their differential associations with adiposity measures in medical students remain unclear. Methods: This cross-sectional study included 256 medical students (63.3% female; mean age 22.1 ± 2.4 years) at Balıkesir University in 2024. Hedonic hunger was assessed using the Power of Food Scale (PFS), and PIU using the Problematic Internet Use Scale (PIUS). Anthropometric measurements included body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR). Multivariable linear and binary logistic regression analyses were performed, together with secondary correlation and group-comparison analyses. Results: Overall, 32.1% of participants had overweight or obesity. Mean PFS and PIUS total scores were 3.25 ± 0.73 and 2.61 ± 0.74, respectively. In multivariable models, higher PFS scores were associated with greater BMI (B = 1.32, p = 0.001) and higher odds of overweight/obesity (OR = 1.79, 95% CI: 1.13–2.84). Higher PIUS scores were associated with waist circumference (B = 3.85, p < 0.001) and WHR (B = 0.023, p = 0.027), but not with BMI. The association between PIUS and waist circumference was stronger in male students (PIUS × sex interaction, p = 0.006). PFS and PIUS scores were positively correlated (r = 0.299, p < 0.001). Conclusions: Hedonic hunger and PIU showed different cross-sectional associations with adiposity measures: hedonic hunger was associated primarily with BMI and overweight/obesity status, whereas PIU was associated with central adiposity measures. The association between PIU and waist circumference differed by sex. Longitudinal studies are needed to clarify the temporal relationships among these variables. Full article

Background/Objectives: Anthropometric machine-learning models may approximate body-composition classifications, but performance can be inflated by inconsistent preprocessing, non-independent validation records, and incomplete calibration reporting. This study evaluated a sex-specific bioelectrical impedance analysis (BIA)-defined high-adiposity phenotype using simple anthropometric variables in adults with and without hypertension. Methods: Of 583 prespecified records, 11 with invalid placeholder-coded values in required anthropometric or body-composition fields were excluded, leaving 572 participants (385 normotensive and 187 hypertensive). A high-adiposity phenotype was defined as BIA-derived body fat ≥ 25% in males or ≥35% in females. Predictors were sex, height, body weight, waist circumference, and hypertension status; body mass index and body-fat percentage were excluded. Eight algorithms were assessed using 10 repetitions of stratified five-fold group cross-validation, with identical predictor profiles kept within the same fold. Continuous predictors were standardized within training folds. Performance was estimated from averaged out-of-fold probabilities with 2000 stratified bootstrap confidence intervals, calibration measures, and SHAP analysis. Results: A high-adiposity phenotype was present in 441 participants (77.1%). Random forest achieved the highest discrimination (ROC AUC = 0.959, PR AUC = 0.980). Gradient boosting provided the strongest threshold-dependent performance (accuracy = 0.937, balanced accuracy = 0.895, sensitivity = 0.973, specificity = 0.817, precision = 0.947, F1 score = 0.960, MCC = 0.817) and the lowest Brier score (0.057), but its calibration slope was 0.462, indicating overconfident probabilities. SHAP analysis identified waist circumference as the largest attribution within the fitted gradient-boosting model; this result must be interpreted jointly with the ablation analysis because sex, height, and body weight are inputs to the proprietary Tanita equation. Conclusions: Simple anthropometric variables classified the prespecified Tanita BIA-derived high-adiposity threshold with strong internal performance after duplicate-aware validation. Sex, height, and body weight alone achieved a ROC AUC of 0.920; adding waist circumference produced a small and uncertain increase in discrimination (ΔROC AUC = 0.0054, 95% CI −0.0060 to 0.0153), whereas hypertension status added a negligible value. The findings represent internal validation of a device-defined outcome, not prediction of an independent biological reference, and require external validation against criterion body-composition methods before clinical application. Full article

Background/Objectives: The 2025 Lancet Diabetes & Endocrinology Commission proposed a framework that distinguishes preclinical from clinical obesity based on confirmed excess adiposity and evidence of obesity-related organ dysfunction. We estimated the prevalence and clinical characteristics of preclinical and clinical obesity in Mexican adults and quantified their discordance with conventional body mass index (BMI) categories. Methods: Cross-sectional analysis of 5014 adults aged ≥20 years (weighted population 77,915,402) from the 2023 Mexican National Health and Nutrition Survey (ENSANUT). Excess adiposity was confirmed by a BMI ≥ 30 kg/m² plus one altered measure of central adiposity, by two altered measures irrespective of BMI, or by a BMI ≥ 40 kg/m² alone. Obesity-related dysfunction was ascertained from available cardiovascular, metabolic, and functional indicators. All analyses accounted for the complex sampling design. Results: Preclinical obesity affected 30.9% of adults and clinical obesity 19.6%. Among adults with clinical obesity, 4.9% had a normal BMI and 18.3% were overweight so that 23.2% fell below the conventional 30 kg/m² threshold. Cardiovascular dysfunction was the most frequent qualifying domain (78.1%), followed by limitations in activities of daily living (27.6%) and metabolic dysfunction (6.7%). Conclusions: BMI alone underestimates obesity-related clinical severity and misses a substantial share of adults with organ dysfunction, supporting the integration of central adiposity measures and assessment of obesity-related dysfunction into routine obesity surveillance. Full article

Sustained consumption of Western-style diets (WDs), rich in fat and cholesterol, challenges metabolic homeostasis and results in organ-specific alterations, notably hepatic lipid accumulation and adipose tissue dysfunction. Medicinal mushrooms such as Ganoderma lucidum have gained attention for their biological activities; however, the extent to which nutritionally realistic dietary intake of G. lucidum modulates tissue-specific metabolic adaptation under obesogenic conditions remains poorly defined. This exploratory study aimed to evaluate how dietary supplementation with a Ganoderma lucidum extract (GLE) modulates metabolic and organ-specific responses in a WD-fed preclinical mouse model. Forty-seven male C57BL/6J mice were assigned to five groups receiving a control diet (CTR), a cholesterol-enriched WD, or the WD supplemented with increasing concentrations of GLE (0.7%, 1.4%, or 2.8%). Over thirteen weeks, body mass and food and water intake were monitored weekly. Afterwards, mice were euthanized, and tissue and blood samples were collected for further analysis. Fasting glucose was lower in WD+2.8% GLE than in CTR, although no GLE-supplemented group differed significantly from WD and glucose tolerance was unchanged. All GLE-supplemented groups had a lower hepatic genetic damage index than WD. WD+1.4% GLE showed a higher frequency of localized periportal hepatic vacuolar changes than WD, whereas WD+2.8% GLE had lower relative liver weight. GLE supplementation was also associated with depot-specific variation in the occurrence of multilocular adipocytes with a beige-like appearance, without significant changes in final body mass or adiposity. In this preclinical model, subchronic dietary GLE was associated with selected tissue-specific differences, most consistently lower hepatic DNA damage and depot-specific variation in multilocular adipocyte morphology, without consistent systemic metabolic improvements. Full article

Background/Objective: Obesity has been linked to a distinct non-allergic, late-onset, neutrophilic asthma phenotype for more than two decades, yet whether obesity should be regarded as a cause of that phenotype rather than a coexisting comorbidity remains unresolved because randomised allocation to obesity is neither feasible nor ethical. This review asks whether the evidence accumulated between 1995 and 2026 supports a causal interpretation. Methods: A structured narrative synthesis was undertaken. PubMed/MEDLINE, Scopus and Web of Science were searched from January 1995 to June 2026 (the synthesis emphasises the 2020–2026 evidence while drawing on the full window for landmark studies) for cohort, cross-sectional, Mendelian randomisation (MR), interventional, mechanistic and pharmaco-epidemiological studies; landmark earlier work was retained where it remains the primary source for a given viewpoint. The retrieved evidence was mapped onto Sir Austin Bradford Hill’s nine viewpoints (1965) and triangulated using E-values for unmeasured confounding, GRADE, directed acyclic graphs and MR. Results: All nine viewpoints were satisfied to varying degrees. Strength: effect estimates 1.4–6.8, E-values 4.8–13.1, MR summary risk ratio 1.05 per 1 kg/m². Consistency: replication across four continents, both sexes and multiple study designs. Temporality: prospective cohort and life-course MR evidence. Biological gradient: body mass index dose–response for TNFα, IL-17A and Th17 frequency. Plausibility: a twelve-layer architecture from adipose dysfunction to bronchial epithelium. Coherence, experimental evidence (bariatric surgery, lifestyle weight loss, GLP-1 receptor agonists, murine and in vitro models) and analogy were also supported; specificity was met at the phenotype level. Conclusions: The cumulative evidence strongly supports a causal contribution of obesity to the development of the late-onset, non-allergic asthma phenotype while falling short of definitive proof (GRADE: moderate certainty), with implications for primary prevention, endotype-targeted therapy and longitudinal research. Phenotype-stratified MR remains the principal missing element of the causal argument. Full article

Background/Objectives: Postmenopausal women are at increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated the associations of anthropometric and hormonal parameters and cardiometabolic risk-factor accumulation with steatosis and MASLD. Methods: In this cross-sectional study, 87 postmenopausal women at a university menopause clinic underwent anthropometric, biochemical, and liver imaging assessment. Hepatic steatosis was defined as CAP ≥ 248 dB/m on transient elastography, and MASLD as steatosis with ≥1 cardiometabolic risk factor (2023 consensus criteria). Anthropometry included body mass index (BMI), waist circumference, mid-upper arm circumference, and triceps skinfold thickness. Results: CAP-defined steatosis (46.0%) closely mirrored MASLD (44.8%; all but one steatotic woman met ≥ 1 criterion). Waist circumference independently correlated with steatosis (OR = 2.77, 95% CI 1.08–7.13, p = 0.035), adding value beyond BMI (Nagelkerke R² 0.202 vs. 0.140). Steatosis burden rose progressively with risk-factor number: each additional factor conferred a 30.59 dB/m CAP increase (95% CI 17.33–43.85, p < 0.001) and 3.38-fold higher odds of steatosis (95% CI 1.59–7.20, p = 0.002; ≥3 vs. 2 factors, Welch’s p = 0.004). Conclusions: MASLD and CAP-defined steatosis were largely coincident. Adiposity correlated with steatosis, but severity was determined chiefly by the accumulation of cardiometabolic risk factors, which is a key determinant of steatotic liver disease severity after menopause. Full article