Unmasking Sarcopenic Obesity in Chronic Hepatitis: A Cross-Sectional Study of Body Composition and Pro-Inflammatory Diets in Lomé, Togo

Abstract

Introduction: In sub-Saharan Africa, the convergence of endemic chronic viral hepatitis and a rising, diet-driven metabolic syndrome presents a "dual burden". This intersection may  accelerate liver disease progression, yet its impact on body composition is poorly understood, particularly as conventional metrics like Body Mass Index (BMI) can mask perilous phenotypes. In Lomé, Togo, a region of high hepatitis B virus (HBV) endemicity, this study aimed to move beyond BMI to characterize the true nutritional and metabolic profiles of patients with chronic hepatitis, focusing on the prevalence of sarcopenic obesity and its association with pro-inflammatory dietary patterns. Methods and Patients: A cross-sectional study was conducted between June and October 2024 at the Lomé University Hospital Centre, recruiting 363 adult patients with chronic hepatitis B or C. Body composition, including visceral fat and protein mass, was assessed using bioelectrical impedance analysis (BIA). Hepatic steatosis was identified from ultrasonography results in patient records, and a semi-quantitative food frequency questionnaire evaluated pro-inflammatory dietary habits. Results: The cohort was predominantly infected with HBV (81.5%) and exhibited significant metabolic comorbidity, with hepatic steatosis present in 55.2% of patients. BIA unmasked a profound nutritional paradox: a high prevalence of visceral obesity (affecting 59.4% of men and 76.7% of women) coexisted with severe protein depletion (found in 59.4% of men and 82.9% of women), the signature of sarcopenic obesity. This adverse phenotype was strongly linked to a pro-inflammatory diet, characterized by near-universal use of industrial bouillon cubes (>86%), regular consumption of sugary products (>88%), and a high dependency on commercially prepared "street food" (76.9%). Conclusion: Patients with chronic hepatitis in Lomé face a synergistic threat from viral infection and a diet-induced metabolic syndrome, manifesting as highly prevalent, clinically occult sarcopenic obesity. The continued reliance on BMI for nutritional assessment is a clinical failure in this population. A paradigm shift in management is imperative, requiring the systematic integration of body composition analysis and the elevation of culturally adapted nutritional therapy to a central pillar of patient care.