Huang Guoqing, Zhang Ping-Ping, Wang Tieqiao, Bao Shixue, Mao Yushan
Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang Province, China.
Ningbo Center for Healthy Lifestyle Research, Chronic Disease Management Office, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang Province, China.
Diabetol Metab Syndr. 2025 Jul 30;17(1):302. doi: 10.1186/s13098-025-01864-9.
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.
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.
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.
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.
代谢功能障碍相关脂肪性肝病（MASLD）是最常见的慢性肝病，严重威胁公众健康。然而，内脏脂肪代谢评分（METS-VF）作为MASLD人群预后标志物的具体作用仍不明确。在本研究中，我们探讨了METS-VF与MASLD人群全因死亡率之间的关联及非线性关系。
本研究纳入了参与美国第三次全国健康与营养检查调查（NHANES III，1988 - 1994）的20岁以上患有MASLD的美国成年人。采用Kaplan-Meier曲线探讨不同METS-VF水平与全因死亡率之间的关系。多变量Cox回归分析用于探讨METS-VF与全因死亡率之间的独立线性关系。此外，使用带有受限立方样条函数的Cox回归和平滑曲线拟合来评估潜在的非线性关联。使用两段式Cox回归模型确定METS-VF的拐点。
在平均23.15年的随访期内，有1413例全因死亡，累积全因死亡率为46.6%。Kaplan-Meier曲线显示，高METS-VF显著增加了MASLD人群的死亡风险。多变量Cox回归分析显示，METS-VF与全因死亡率独立相关（风险比[HR]：1.121；95%置信区间[CI]：1.103 - 1.139；P < 0.001）。带有受限立方样条函数的Cox回归和平滑曲线拟合显示METS-VF与全因死亡率之间呈J形关系，拐点为6.394。拐点之前HR为1.068（95% CI：1.038 - 1.
