People with non-hepatic steatosis combined with metabolic dysfunction as defined by atherosclerotic plaques are at higher risk of early liver fibrosis

ObjectiveThis study examines the association between hepatic steatosis (HS) and liver fibrosis risk in individuals with similar metabolic disorders but differing metabolic dysfunction indicators. MethodsA cross-sectional study was conducted at the First Hospital of Lanzhou University from January to November 2024, involving individuals undergoing physical examinations. Laboratory tests, vascular and abdominal ultrasound examinations, and clinical data were collected to assess metabolic characteristics. Logistic regression models were used to explore the relationship between metabolic dysfunction, HS, and liver fibrosis degree. ResultsA total of 4,006 patients were included, with 1,164 (29.06%) females and 2,157 (53.84%) having HS. Univariate logistic regression identified HS as a risk factor for early liver fibrosis (odds ratio [OR]: 1.67, 95% CI: 1.47-1.89, P < 0.001). However, after adjusting for metabolic dysfunction indicators, the correlation between HS and liver fibrosis risk weakened or reversed. Multivariate analysis, accounting for confounders, found HS to be a protective factor (OR: 0.57, 95% CI: 0.45-0.71, P < 0.001), while body roundness index (OR: 1.62, 95% CI: 1.32- 2.00, P < 0.001) and hyperglycemia (OR: 13.28, 95% CI: 10.76-16.39, P < 0.001) were identified as risk factors. Propensity score matching revealed 880 matched pairs of patients, showing that among those with atherosclerotic plaques (OR: 0.58, 95% CI: 0.42-0.79, P < 0.001) or hyperglycemia (OR: 0.63, 95% CI: 0.43-0.93, P = 0.02), HS was associated with a reduced risk of early liver fibrosis. The non-HS group had the strongest ability to detect early liver fibrosis (AUC: 0.57, 95% CI: 0.52-0.61, P = 0.003). ConclusionMetabolic dysfunction is positively correlated with the risk of liver fibrosis. However, in individuals with metabolic dysfunction, particularly those with atherosclerotic plaque formation, the non-HS population is at a higher risk of early liver fibrosis. Financial supportNational Natural Science Foundation of China (82360132), Major Science and Technology Innovation Project of Gansu Provincial Health Industry (GSWSZD2024-11), Joint Scientific Research Fund of Gansu Province (23JRRA1489, 24JRRA911), Key Talent Project of Gansu Province (GanZuTongZi [2024] No.4), Open Project of Gansu Provincial Key Laboratory of Extreme Environment Microbiology (EEMRE202401), Key Research and Development Program of Gansu Province (22YF7FA085), Key Project of Traditional Chinese Medicine in Gansu Province (GZKZ-2022-7), Lanzhou Science and Technology Bureau Project (2023-2-76), and Medical Education Development Projects of Lanzhou University (lzuyxcx-2022-131; lzuyxcx-2022-213; lzuyxcx-2022-147).