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Background <p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, seriously threatening the public health. However, the specific role of metabolic score of visceral fat (METS-VF) as a prognostic marker in the MASLD population remains unclear. In this study, we explored the association and nonlinear relationship between METS-VF and all-cause mortality among MASLD population.</p> Methods <p>This study included American adults aged over 20 years with MASLD who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994) in the United States. Kaplan–Meier curve was used to explore the relationship between different METS-VF levels and all-cause mortality. Multivariable Cox regression analysis was used to explore the independent linear relationship between METS-VF and all-cause mortality. In addition, Cox regression with restricted cubic spline functions and smooth curve fitting were used to evaluate potential nonlinear associations. An inflection point of METS-VF was determined using a two-piece Cox regression model.</p> Results <p>During an average follow-up period of 23.15 years, there were 1,413 all-cause deaths and the cumulative all-cause mortality proportion was 46.6%. Kaplan–Meier curve revealed that high METS-VF significantly increased the mortality risk in the MASLD population. Multivariate Cox regression analysis revealed that METS-VF was independently associated with all-cause mortality (hazard ratio [HR]: 1.121; 95% confidence interval [CI]: 1.103–1.139; <i>P</i> &lt; 0.001). Cox regression with restricted cubic spline functions and smooth curve fitting showed a J-shaped relationship between METS-VF and all-cause mortality, with an inflection point of 6.394. The HR was 1.068 (95% CI: 1.038–1.099, <i>P</i> &lt; 0.001) before the inflection point and 1.143 (95% CI: 1.122–1.166, <i>P</i> &lt; 0.001) after it.</p> Conclusion <p>This study reveals that higher METS-VF levels are significantly associated with an increased risk of all-cause mortality in individuals with MASLD, characterized by a J-shaped non-linear relationship. This finding provides a new indicator for prognosis assessment in the MASLD population.</p>

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Association between metabolic score of visceral fat and all-cause mortality among individuals with metabolic dysfunction-associated steatotic liver disease: a follow-up study based on NHANES III (1988–1994)

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  • 发表日期：

    2025年7月30日

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  • Guoqing Huang,
  • Ping-Ping Zhang,
  • Tieqiao Wang,
  • Shixue Bao,
  • Yushan Mao

摘要

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, seriously threatening the public health. However, the specific role of metabolic score of visceral fat (METS-VF) as a prognostic marker in the MASLD population remains unclear. In this study, we explored the association and nonlinear relationship between METS-VF and all-cause mortality among MASLD population.

Methods

This study included American adults aged over 20 years with MASLD who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994) in the United States. Kaplan–Meier curve was used to explore the relationship between different METS-VF levels and all-cause mortality. Multivariable Cox regression analysis was used to explore the independent linear relationship between METS-VF and all-cause mortality. In addition, Cox regression with restricted cubic spline functions and smooth curve fitting were used to evaluate potential nonlinear associations. An inflection point of METS-VF was determined using a two-piece Cox regression model.

Results

During an average follow-up period of 23.15 years, there were 1,413 all-cause deaths and the cumulative all-cause mortality proportion was 46.6%. Kaplan–Meier curve revealed that high METS-VF significantly increased the mortality risk in the MASLD population. Multivariate Cox regression analysis revealed that METS-VF was independently associated with all-cause mortality (hazard ratio [HR]: 1.121; 95% confidence interval [CI]: 1.103–1.139; P < 0.001). Cox regression with restricted cubic spline functions and smooth curve fitting showed a J-shaped relationship between METS-VF and all-cause mortality, with an inflection point of 6.394. The HR was 1.068 (95% CI: 1.038–1.099, P < 0.001) before the inflection point and 1.143 (95% CI: 1.122–1.166, P < 0.001) after it.

Conclusion

This study reveals that higher METS-VF levels are significantly associated with an increased risk of all-cause mortality in individuals with MASLD, characterized by a J-shaped non-linear relationship. This finding provides a new indicator for prognosis assessment in the MASLD population.