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已发表论文
代谢功能障碍相关脂肪性肝病和肝纤维化与中美人群的晚期心血管-肾脏-代谢综合征相关
Authors Hu S , Wang D, Yu Q, Chen Z, Lu W, Meng Y, Peng X, Liu L, Wan H , Shen J
Received 29 September 2025
Accepted for publication 11 December 2025
Published 23 December 2025 Volume 2025:18 Pages 4699—4713
DOI https://doi.org/10.2147/DMSO.S569698
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Jae Woong Sull
Shidi Hu,1,2,* Dongmei Wang,1,* Qingtao Yu,1,* Zhi Chen,1 Weiguo Lu,3 Yuan Meng,4 Xuetao Peng,4 Lan Liu,1,4 Heng Wan,1,4 Jie Shen1,4
1Department of Endocrinology and Metabolism, The Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 3Department of General Medicine, Shunde Lunjiao Community Healthcare Center, Foshan, Guangdong, People’s Republic of China; 4GuangDong Engineering Technology Research Center of Metabolic Disorders Interdisciplinary Precision Prevention and Digital Healthcare, The Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jie Shen, Department of Endocrinology and Metabolism, the Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), No. 1 of Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong, 528308, People’s Republic of China, Email sjiesy@smu.edu.cn Heng Wan, Department of Endocrinology and Metabolism, the Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), No. 1 of Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong, 528308, People’s Republic of China, Email wanhdr@163.com
Purpose: Despite the pathophysiologic overlap between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular-kidney-metabolic (CKM) syndrome, MASLD has not been incorporated into the current CKM framework. This study examined the associations of MASLD and MASLD-related fibrosis with advanced CKM syndrome in Chinese and US populations.
Patients and Methods: We enrolled 6186 participants in a community-based cross-sectional study conducted in China, with validation utilizing the National Health and Nutrition Examination Survey (NHANES). Advanced CKM syndrome was defined as stages 3 and 4. Hepatic steatosis and fibrosis were assessed via vibration-controlled transient elastography. Multivariable logistic regression and restricted cubic spline (RCS) analyses were employed.
Results: Advanced CKM syndrome was present in 8.8% of the Chinese and 14.9% of the US populations. MASLD participants exhibited a significantly higher prevalence of advanced CKM than those without (China: 12.6% vs 6.4%; US: 21.5% vs 9.9%). In addition, participants with MASLD were associated with increased odds of advanced CKM (China: OR 2.06, 95% CI: 1.64– 2.58; US: OR 1.60, 95% CI: 1.22– 2.10; both P < 0.01). Among participants with MASLD, advanced CKM syndrome was more prevalent in participants with fibrosis than without (China: 17.1% vs 11.2%; US: 28.4% vs 20.1%). MASLD-related fibrosis was also independently linked to higher odds of advanced CKM compared to non-fibrotic MASLD (China: OR 1.55, 95% CI: 1.09– 2.18; US: OR 1.44, 95% CI: 1.01– 2.05; both P < 0.05). Furthermore, RCS analysis revealed a positive linear relationship of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) values with the prevalence of advanced CKM syndrome (P non-linear > 0.05).
Conclusion: MASLD and MASLD-related fibrosis were significantly associated with a higher prevalence of advanced CKM syndrome, and higher CAP/LSM levels showed linear associations with advanced CKM syndrome in both Chinese and US populations. These findings support evaluating liver health (eg, CAP/LSM) when risk-stratifying CKM syndrome.
Keywords: advanced cardiovascular-kidney-metabolic syndrome, controlled attenuation parameter, fibrosis, liver stiffness measurement, metabolic dysfunction-associated steatotic liver disease
1Department of Endocrinology and Metabolism, The Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 3Department of General Medicine, Shunde Lunjiao Community Healthcare Center, Foshan, Guangdong, People’s Republic of China; 4GuangDong Engineering Technology Research Center of Metabolic Disorders Interdisciplinary Precision Prevention and Digital Healthcare, The Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jie Shen, Department of Endocrinology and Metabolism, the Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), No. 1 of Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong, 528308, People’s Republic of China, Email sjiesy@smu.edu.cn Heng Wan, Department of Endocrinology and Metabolism, the Eighth Affiliated Hospital, Southern Medical University (The First People’s Hospital of Shunde), No. 1 of Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong, 528308, People’s Republic of China, Email wanhdr@163.com
Purpose: Despite the pathophysiologic overlap between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular-kidney-metabolic (CKM) syndrome, MASLD has not been incorporated into the current CKM framework. This study examined the associations of MASLD and MASLD-related fibrosis with advanced CKM syndrome in Chinese and US populations.
Patients and Methods: We enrolled 6186 participants in a community-based cross-sectional study conducted in China, with validation utilizing the National Health and Nutrition Examination Survey (NHANES). Advanced CKM syndrome was defined as stages 3 and 4. Hepatic steatosis and fibrosis were assessed via vibration-controlled transient elastography. Multivariable logistic regression and restricted cubic spline (RCS) analyses were employed.
Results: Advanced CKM syndrome was present in 8.8% of the Chinese and 14.9% of the US populations. MASLD participants exhibited a significantly higher prevalence of advanced CKM than those without (China: 12.6% vs 6.4%; US: 21.5% vs 9.9%). In addition, participants with MASLD were associated with increased odds of advanced CKM (China: OR 2.06, 95% CI: 1.64– 2.58; US: OR 1.60, 95% CI: 1.22– 2.10; both P < 0.01). Among participants with MASLD, advanced CKM syndrome was more prevalent in participants with fibrosis than without (China: 17.1% vs 11.2%; US: 28.4% vs 20.1%). MASLD-related fibrosis was also independently linked to higher odds of advanced CKM compared to non-fibrotic MASLD (China: OR 1.55, 95% CI: 1.09– 2.18; US: OR 1.44, 95% CI: 1.01– 2.05; both P < 0.05). Furthermore, RCS analysis revealed a positive linear relationship of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) values with the prevalence of advanced CKM syndrome (P non-linear > 0.05).
Conclusion: MASLD and MASLD-related fibrosis were significantly associated with a higher prevalence of advanced CKM syndrome, and higher CAP/LSM levels showed linear associations with advanced CKM syndrome in both Chinese and US populations. These findings support evaluating liver health (eg, CAP/LSM) when risk-stratifying CKM syndrome.
Keywords: advanced cardiovascular-kidney-metabolic syndrome, controlled attenuation parameter, fibrosis, liver stiffness measurement, metabolic dysfunction-associated steatotic liver disease