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Background <p>Relative fat mass (RFM) is a simple anthropometric indicator of body fat. Although its association with hepatic steatosis has been examined in previous studies, its predictive value for the more severe stages of liver disease, specifically advanced hepatic fibrosis (AHF) and cirrhosis, has not been systematically evaluated. This study aimed to explore the associations between RFM and the presence of MASLD, AHF, and cirrhosis.</p> Methods <p>We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2023. Logistic regression models were constructed to estimate the associations of RFM with the prevalence of MASLD, AHF, and cirrhosis, adjusting for relevant demographic, lifestyle, and clinical covariates. To facilitate clinical interpretation, odds ratios (ORs) were calculated per standard deviation (SD) increase in RFM. Restricted cubic spline (RCS) models were applied to explore the nonlinear relationships. Subgroup analyses were conducted to assess robustness, and mediation analyses were performed to evaluate the potential indirect effects of diabetes and dyslipidemia.</p> Results <p>Among 5,327 participants, 2,453 had MASLD, 230 had AHF, and 93 had cirrhosis. When analyzed per SD increase in RFM, the adjusted ORs were 1.93 (95% CI: 1.64–2.27) for MASLD, 1.98 (95% CI: 1.45–2.71) for AHF, and 1.83 (95% CI: 1.33–2.52) for cirrhosis, indicating substantial clinical relevance. Nonlinear associations were observed in spline analyses. The associations were generally consistent across subgroups. Mediation analysis indicated partial mediation by diabetes and dyslipidemia.</p> Conclusion <p>This study suggests that higher RFM is positively and nonlinearly associated with MASLD, and more importantly, with the risk of AHF and cirrhosis. Given its simplicity and non-invasiveness, RFM may serve as a practical adjunct screening indicator for identifying individuals at elevated risk of advanced fibrosis within the MASLD spectrum. Longitudinal studies are needed to validate these findings.</p>

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Associations of relative fat mass with metabolic dysfunction–associated steatotic liver disease and liver fibrosis: evidence from the U.S. NHANES 2017–2023

  • 期刊论文

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  • 发表日期：

    2026年1月28日

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  • Hai-Yuan Zhong,
  • Ling-Dan Ma,
  • Jin-Cheng Li,
  • Dan Jiang,
  • Yu-Mei Qin,
  • Ming-Yu Lai,
  • Guang Xiong

摘要

Background

Relative fat mass (RFM) is a simple anthropometric indicator of body fat. Although its association with hepatic steatosis has been examined in previous studies, its predictive value for the more severe stages of liver disease, specifically advanced hepatic fibrosis (AHF) and cirrhosis, has not been systematically evaluated. This study aimed to explore the associations between RFM and the presence of MASLD, AHF, and cirrhosis.

Methods

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2023. Logistic regression models were constructed to estimate the associations of RFM with the prevalence of MASLD, AHF, and cirrhosis, adjusting for relevant demographic, lifestyle, and clinical covariates. To facilitate clinical interpretation, odds ratios (ORs) were calculated per standard deviation (SD) increase in RFM. Restricted cubic spline (RCS) models were applied to explore the nonlinear relationships. Subgroup analyses were conducted to assess robustness, and mediation analyses were performed to evaluate the potential indirect effects of diabetes and dyslipidemia.

Results

Among 5,327 participants, 2,453 had MASLD, 230 had AHF, and 93 had cirrhosis. When analyzed per SD increase in RFM, the adjusted ORs were 1.93 (95% CI: 1.64–2.27) for MASLD, 1.98 (95% CI: 1.45–2.71) for AHF, and 1.83 (95% CI: 1.33–2.52) for cirrhosis, indicating substantial clinical relevance. Nonlinear associations were observed in spline analyses. The associations were generally consistent across subgroups. Mediation analysis indicated partial mediation by diabetes and dyslipidemia.

Conclusion

This study suggests that higher RFM is positively and nonlinearly associated with MASLD, and more importantly, with the risk of AHF and cirrhosis. Given its simplicity and non-invasiveness, RFM may serve as a practical adjunct screening indicator for identifying individuals at elevated risk of advanced fibrosis within the MASLD spectrum. Longitudinal studies are needed to validate these findings.