Luo Jian, Gong Danfeng, Guo Min, Cheng Long, Wu Xueyan
Department of Endocrinology, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China.
Department of Gastroenterology, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China.
Front Med (Lausanne). 2025 Sep 1;12:1569655. doi: 10.3389/fmed.2025.1569655. eCollection 2025.
The role of basal metabolic rate (BMR) in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains controversial, with previous studies yielding inconsistent results. The precise relationship remains poorly understood, particularly in non-obese individuals. This study aimed to investigate the longitudinal association between BMR and incident MASLD in a large, non-obese Chinese cohort.
This longitudinal cohort study included 16,173 non-obese participants free of MASLD at baseline. They were prospectively followed up for 5 years, with the outcome event being the development of MASLD. Participants were divided into quartiles based on their basal metabolic rate (BMR). The association between BMR and incident MASLD was examined using both Cox regression models and restricted cubic spline analysis (RCS).
During the 5-year follow-up period, 2,322 non-obese participants developed MASLD. Multivariate Cox regression analysis revealed that after fully adjusting for relevant confounding factors, the BMR was positively associated with incident MASLD, and the risk of MASLD gradually increased with increasing BMR (HR: 1.3, 95% CI: 1.3, 1.4; for trend < 0.0001). Using RCS regression, we found a positive linear correlation between the BMR and the risk of incident MASLD. Stratified analysis revealed an association between the BMR and increased incidence of MASLD in all the subgroups. Additionally, significant interactions were found between BMR and sex, systolic blood pressure (SBP), uric acid (UA), creatinine (CR), and triglycerides (TGs) ( for interaction < 0.05). Mediation analysis indicated that insulin resistance mediated 5.16% of the effect of the BMR on incident MASLD.
In this non-obese Chinese cohort, an elevated BMR was identified as an independent risk factor for incident MASLD. This suggests that BMR could be a valuable early biomarker for MASLD risk stratification, even in individuals without obesity.
基础代谢率（BMR）在代谢功能障碍相关脂肪性肝病（MASLD）中的作用仍存在争议，以往研究结果不一致。其确切关系仍知之甚少，尤其是在非肥胖个体中。本研究旨在调查大型非肥胖中国队列中BMR与新发MASLD之间的纵向关联。
这项纵向队列研究纳入了16173名基线时无MASLD的非肥胖参与者。对他们进行了5年的前瞻性随访，结局事件为MASLD的发生。参与者根据其基础代谢率（BMR）分为四分位数。使用Cox回归模型和限制性立方样条分析（RCS）检查BMR与新发MASLD之间的关联。
在5年随访期内，2322名非肥胖参与者发生了MASLD。多变量Cox回归分析显示，在充分调整相关混杂因素后，BMR与新发MASLD呈正相关，且MASLD风险随BMR升高而逐渐增加（风险比：1.3，95%置信区间：1.3，1.4；趋势P<0.0001）。使用RCS回归，我们发现BMR与新发MASLD风险之间存在正线性相关性。分层分析显示，在所有亚组中BMR与MASLD发病率增加之间均存在关联。此外，还发现BMR与性别、收缩压（SBP）、尿酸（UA）、肌酐（CR）和甘油三酯（TGs）之间存在显著交互作用（交互作用P<0.05）。中介分析表明，胰岛素抵抗介导了BMR对新发MASLD影响的5.16%。
在这个非肥胖中国队列中，较高的BMR被确定为新发MASLD的独立危险因素。这表明，即使在无肥胖个体中，BMR也可能是用于MASLD风险分层的有价值的早期生物标志物。
