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Background <p>Preserved Ratio Impaired Spirometry (PRISm) is related to increased morbidity and mortality. Recently, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated alcohol-related liver disease (Met-ALD), and alcohol-associated liver disease (ALD) have been recognized as systemic metabolic disorders. The association between these novel liver disease categories and PRISm remains unclear.</p> Methods <p>We analyzed data from 23,414 adults aged ≥ 40 years from the 2010–2019 Korean National Health and Nutrition Examination Survey. Participants with obstructive lung patterns were excluded. MASLD, Met-ALD, and ALD were defined based on hepatic steatosis index, cardiometabolic criteria, and alcohol consumption. PRISm was defined as FEV₁/FVC ≥ 0.7 and FEV₁ &lt;80% predicted. Complex sample logistic regression was used to examine associations, adjusting for sociodemographic, behavioral, and clinical variables. Subgroup analyses by sex and sensitivity analyses using AST-to-platelet index (APRI) for advanced fibrosis and lower limit of normal (LLN)-based criteria for PRISm were performed.</p> Results <p>Among the study population, 3,182 had PRISm. MASLD, Met-ALD, and ALD were more prevalent in the PRISm group than in the normal spirometry group. In fully adjusted models, MASLD (OR 1.36; 95% CI, 1.19–1.55) and Met-ALD (OR 1.51; 95% CI, 1.14–2.01), and ALD (OR 2.38; 95% CI, 1.65–3.41) were associated with increased odds of PRISm. These associations were significant in males but not in females. Sensitivity analyses using LLN showed consistent results. Participants with advanced fibrosis (APRI ≥ 0.34) also had higher odds of PRISm in both sexes.</p> Conclusion <p>MASLD, Met-ALD, and ALD are associated with PRISm, particularly in men, suggesting a possible link between liver-based metabolic dysfunction and non-obstructive pulmonary impairment. These findings highlight the need for integrated approaches to managing metabolic liver disease and lung function decline.</p>

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Association between steatotic liver disease (MASLD, met-ALD, and ALD) with preserved ratio impaired spirometry: a population-based study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月6日

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  • Sumin Jo,
  • Hyunji Choi,
  • Jaejun Lee,
  • Taeyun Kim

摘要

Background

Preserved Ratio Impaired Spirometry (PRISm) is related to increased morbidity and mortality. Recently, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated alcohol-related liver disease (Met-ALD), and alcohol-associated liver disease (ALD) have been recognized as systemic metabolic disorders. The association between these novel liver disease categories and PRISm remains unclear.

Methods

We analyzed data from 23,414 adults aged ≥ 40 years from the 2010–2019 Korean National Health and Nutrition Examination Survey. Participants with obstructive lung patterns were excluded. MASLD, Met-ALD, and ALD were defined based on hepatic steatosis index, cardiometabolic criteria, and alcohol consumption. PRISm was defined as FEV₁/FVC ≥ 0.7 and FEV₁ <80% predicted. Complex sample logistic regression was used to examine associations, adjusting for sociodemographic, behavioral, and clinical variables. Subgroup analyses by sex and sensitivity analyses using AST-to-platelet index (APRI) for advanced fibrosis and lower limit of normal (LLN)-based criteria for PRISm were performed.

Results

Among the study population, 3,182 had PRISm. MASLD, Met-ALD, and ALD were more prevalent in the PRISm group than in the normal spirometry group. In fully adjusted models, MASLD (OR 1.36; 95% CI, 1.19–1.55) and Met-ALD (OR 1.51; 95% CI, 1.14–2.01), and ALD (OR 2.38; 95% CI, 1.65–3.41) were associated with increased odds of PRISm. These associations were significant in males but not in females. Sensitivity analyses using LLN showed consistent results. Participants with advanced fibrosis (APRI ≥ 0.34) also had higher odds of PRISm in both sexes.

Conclusion

MASLD, Met-ALD, and ALD are associated with PRISm, particularly in men, suggesting a possible link between liver-based metabolic dysfunction and non-obstructive pulmonary impairment. These findings highlight the need for integrated approaches to managing metabolic liver disease and lung function decline.