Kouvari M, Chrysohoou C, Skoumas J, et al. - Even when only validated indices are used, considering non-alcoholic fatty liver disease (NAFLD) in the clinical assessment of apparently healthy obese individuals predicts who will develop metabolically unhealthy obesity and contributes independently and more accurately to defining future cardiometabolic risk.

• A total of 1,514 (49·8%) men and 1,528 (50.2%) women (aged >18 years old) free-of-CVD were involved.

• The prevalence of NAFLD among metabolically healthy obese (MHO) participants ranged from 29% to 39% depending on the NAFLD score employed.

• MHO participants that gained metabolically unhealthy status had approximately two times the odds of having NAFLD at baseline compared with their metabolically healthy normal weight counterparts, although stable MHO was not significantly linked to NAFLD.

• Furthermore, MHO status combined with NAFLD was related to an elevated CVD risk when compared with non-NAFLD MHO peers.

• Further investigation found that in the obese, NAFLD indicators, rather than just visceral adiposity, greatly boosted the ability of metabolic status (as defined by the standard definition) to predict long-term CVD incidence.