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. 2025 Sep 26;25(1):650.
doi: 10.1186/s12876-025-04130-4.

Association between the ApoB/ApoA1 ratio and both the severity and mortality of metabolic dysfunction-associated fatty liver disease

Chao Fu #  1   2 , Yan Gong #  1 , Xiangyang Gao  1 , Yuxin Li  3 , Guanyun Wang  4 , Bingqing Han  1 , Shanshan Liu  1 , Hao Zhang  1 , Dengxin He  5 , Fei Wang  6 , Qiang Zeng  7
Affiliations

Association between the ApoB/ApoA1 ratio and both the severity and mortality of metabolic dysfunction-associated fatty liver disease

Chao Fu et al. BMC Gastroenterol. .
No abstract available

Keywords: All-cause and cause-specific mortality; MAFLD; the ApoB/ApoA1 ratio.

Plain language summary

This study investigates the association between the ApoB/ApoA1 ratio and MAFLD along with its hepatic steatosis severity in both Chinese and American populations. Using data from the NHANES, the analysis further evaluated relationships between the ApoB/ApoA1 ratio and both all-cause and cause-specific mortality among MAFLD patients.• The ApoB/ApoA1 ratio represents an important predictive biomarker for assessing MAFLD severity and hepatic steatosis progression.• The ApoB/ApoA1 ratio also functions as a valuable prognostic indicator, with insulin resistance-related parameters mediating its association with all-cause mortality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All survey protocols were approved by the institutional review board of the National Center for Health Statistics. The research adhered to the Declaration of Helsinki and received approval from the Ethics Committee of the PLA General Hospital. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Association between the ApoB/ApoA1 ratio and both MAFLD and its severity. Abbreviation: ApoA1, apolipoprotein A1; ApoB, Apolipoprotein B; MAFLD, metabolic dysfunction-associated fatty liver disease; OR, odds ratio; CI, confidence interval
Fig. 2
Fig. 2
Kaplan-Meier survival curves showing associations between the ApoB/ApoA1 ratio and all-cause mortality (A), cardiovascular-related mortality (B), and diabetes-related mortality (C) in the MAFLD population. Abbreviation: ApoA1, apolipoprotein A1; ApoB, Apolipoprotein B
Fig. 3
Fig. 3
Non-linear trends of the ApoB/ApoA1 ratio with all-cause and cause-specific mortality of MAFLD population. A-C represents the relationship between ApoB/ApoA1 ratio and all-cause mortality (A), cardiovascular-related mortality (B), and diabetes-related mortality (C) in the MAFLD population. Abbreviation: ApoA1, apolipoprotein A1; ApoB, Apolipoprotein B; MAFLD, metabolic dysfunction-associated fatty liver disease; HR: hazard ratios; CI: confidence interval
Fig. 4
Fig. 4
Subgroup analysis of ApoB/ApoA1 ratio and both all-cause and cause-specific mortality in MAFLD population. A-C represents the subgroup analysis between ApoB/ApoA1 ratio and all-cause mortality (A), cardiovascular-related mortality (B), and diabetes-related mortality (C) in the MAFLD population. Abbreviation: ApoA1, apolipoprotein A1; ApoB, Apolipoprotein B; MAFLD, metabolic dysfunction-associated fatty liver disease; HR: hazard ratios; CI: confidence interval
Fig. 5
Fig. 5
The mediating effect of insulin resistance indicators on the relationship between the ApoB/ApoA1 ratio and all-cause mortality. A The mediating effect of TyG-BMI on the relationship between the ApoB/ApoA1 ratio and all-cause mortality; (B) The mediating effect of HOMA-IR on the relationship between the ApoB/ApoA1 ratio and all-cause mortality. Abbreviations: ApoA1, apolipoprotein A1; ApoB, Apolipoprotein B; ACME, average causal mediation effect; ADE, average direct effect; TyG-BMI, triglyceride glucose-body mass index; HOMA-IR, homeostatic model assessment of insulin resistance
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