Association between cardiovascular health and metabolic dysfunction-associated steatotic liver disease: a nationwide cross-sectional study

Abstract

Purpose: Evidence concerning the effect of cardiovascular health (CVH) on the risk of metabolic dysfunctional-associated steatotic liver disease (MASLD) is scarce. This study aimed to investigate the association between CVH and MASLD.

Methods: 5680 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey 2017-March 2020 were included. Life's essential 8 (LE8) was applied to assess CVH. Weighted binary logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of CVH with MASLD. Restricted cubic spline (RCS) was conducted to explore the dose-response association between LE8 and its subscales scores with MASLD.

Results: Among 5680 participants, 724, 3901, and 1055 had low, moderate, and high CVH levels, respectively, with a MASLD diagnosis prevalence of 36.83%. In the fully adjusted logistic regression model, ORs for MASLD were 0.50 (95% CI, 0.37-0.69) for participants with moderate CVH and 0.21 (95% CI, 0.13-0.34) for those with high CVH, when compared to those with low CVH (P < 0.001 for trend). OR for MASLD was 0.68 (95% CI, 0.61-0.77) for each 10-point increase in LE8 score. RCS model demonstrated a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Subgroup analysis showed a consistent negative correlation between LE8 score and MASLD, and sensitivity analysis validated the reliability of these findings.

Conclusions: Higher LE8 score was associated with a lower risk of MASLD. Encouraging adherence to optimal CVH levels may help mitigate the burden of MASLD.

Keywords: Cardiovascular health; Life’s essential 8; MASLD; NHANES.

Fig. 1

Flowchart of participant selection. NHANES, National Health and Nutrition Examination Survey; VCTE, vibration controlled transient elastography; CAP, controlled attenuation parameter; CVH, cardiovascular health; AST, aspartate aminotransferase; MASLD, metabolic dysfunction-associated steatotic liver disease

Fig. 2

Age-adjusted prevalence of MASLD in different levels of CVH. Bar whiskers represent the 95% confidence level. MASLD, metabolic dysfunction-associated steatotic liver disease; CVH, cardiovascular health

Fig. 3

Dose–response relationships between LE8 score (A), health behaviors score (B), health factors score (C), and MASLD. ORs (solid lines) and 95% CIs (shaded areas) were adjusted for age (as a continuous variable), gender, race/ethnicity, education level, marital status, poverty income ratio (as a continuous variable), serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, obesity, thyroid disease history, and sleep apnea. Vertical dotted lines indicate the minimal threshold for the beneficial association with estimated OR = 1. LE8, Life’s Essential 8; MASLD, metabolic dysfunction-associated steatotic liver disease; OR, odds ratio; CI, confidence interval

Fig. 4

Subgroup analysis of association of LE8 score and MASLD. ORs were calculated as per 10 points increase in LE8 score. Each stratification was adjusted for age (as a continuous variable), gender, race/ethnicity, education level, marital status, poverty income ratio (as a continuous variable), serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, obesity, thyroid disease history, and sleep apnea. LE8, Life’s Essential 8; MASLD, metabolic dysfunction-associated steatotic liver disease; OR, odds ratio; CI, confidence interval