Zhonghua Gan Zang Bing Za Zhi. 2026 Aug 20;34(8):757-768. doi: 10.3760/cma.j.cn501113-20260609-00241.
ABSTRACT
Objective: To investigate the association between steatotic liver disease (SLD) and its clinical subtypes with metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), hypertension (HTN), chronic kidney disease (CKD), cardiovascular disease (CVD), and extrahepatic malignancies, as well as the impact of cardiovascular health scores on these aforementioned comorbidities. Methods: A cross-sectional analysis was conducted within a subcohort of the Malignancy Occurrence Risk Epidemiology Study, based on baseline data from the Shanghai Chongming Town Community Residents Cohort (March-November, 2011) among Chinese patients with type 2 diabetes mellitus. Sonographically diagnosed SLD was classified into metabolic-associated fatty liver disease (MASLD), metabolic and alcohol-associated fatty liver disease (MetALD), alcoholic liver disease (ALD), and SLD of other causes according to metabolic cardiovascular risk factors and alcohol consumption. Cardiovascular health status was assessed using the LE8 (Life's Essential 8) score. Intergroup differences were compared using appropriate parametric or nonparametric tests. The association between the prevalence of extrahepatic comorbidities and LE8 scores was analyzed using a multivariate logistic regression models. Results: The prevalence rates of SLD and its subtypes, MASLD, MetALD, and ALD were 42.15% (4 122/9 779), 39.00% (3 814/9 779), 1.48% (145/9 779), and 1.57% (154/9 779), respectively, among 9 779 subjects aged 40 -70 years. The prevalence rates of T2DM, HTN, CKD, and CVD were significantly higher in the high-risk liver fibrosis index-4 group (FIB-4>2.67) than in the non-high-risk group (P<0.05). The prevalence rates of T2DM, HTN, CKD, and CVD metabolic disorders were significantly higher in patients with SLD than patients with non-SLD (P<0.05). MetALD and ALD patients had higher prevalence rates of HTN than patients with MASLD (P<0.05). All ALD patients had combined metabolic cardiovascular risk factors, with the prevalence rates of MetS, T2DM, HTN, and CVD showing an increasing trend from MASLD to MetALD to ALD. However, no significant differences were observed in the history of extrahepatic malignancies between SLD and non-SLD groups or among subgroups. Multivariate logistic regression analysis revealed that the LE8 score was significantly negatively correlated with T2DM and HTN prevalence rates in the overall population, validating a preventive impact in groups of patients with SLD and non-SLD as well as MASLD (P<0.05). Conclusion: Cardiovascular-renal-metabolic diseases impose a substantial burden on patients with SLD, while metabolic disorders are more pronounced among patients with ALD. The development of extrahepatic comorbidities is jointly driven by overnutrition and harmful alcohol consumption in patients with MetALD and ALD. LE8 is beneficial for multidimensional risk assessment and interventions targeting for T2DM and HTN in patients with SLD.
PMID:42706037 | DOI:10.3760/cma.j.cn501113-20260609-00241