September 26, 2025BMC Cardiovascular Disorders4 citationsOpen Access

Association of weight-adjusted waist index with all-cause and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease: a national population-based cohort study

FZFan ZhangXuzhou Medical College YHYan HanNanjing Medical University YMYong-Hua MaoBeijing Normal University

Structured PICO

Does a higher weight-adjusted waist index (WWI) predict increased all-cause and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD)?

Population

17,785 patients with metabolic dysfunction-associated steatotic liver disease (MASLD) from the NHANES database (1999-2018), median age 52.00, 55.71% male, US-based. Key inclusion: MASLD diagnosis based on calculating fatty liver index (FLI) values (FLI ≥ 60) and combining five cardiometabolic criteria.

Intervention

Higher weight-adjusted waist index (WWI), evaluated as a continuous variable and in quartiles

Comparator

Lower weight-adjusted waist index (WWI) quartiles

Outcome

All-cause mortality and cardiovascular mortality (deaths due to heart disease and cerebrovascular disease)hard clinical

Weight-adjusted waist index (WWI) is a significant, independent predictor of all-cause and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Abstract

OBJECTIVE: This study aims to investigate the correlation between weight-adjusted waist index (WWI) and all-cause and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and to determine whether WWI can be utilized as an independent predictor for prognostic assessment in patients with MASLD. METHODS: This study was based on data from the 1999-2018 National Health and Nutrition Examination Survey database, which included 17,785 patients with MASLD. The diagnosis of MASLD was based on calculating fatty liver index values and combining five cardiometabolic criteria. Cox proportional hazard regression models were employed to examine the relationship between WWI and all-cause mortality and cardiovascular mortality in patients with MASLD while adjusted for potential confounding variables such as gender, age, and race. Furthermore, the dose-response relationship between WWI and mortality was evaluated using Kaplan-Meier survival curves and restricted cubic spline plots (RCS). Subgroup analyses were conducted to investigate the prognostic impact of different clinical characteristics. RESULTS: The results demonstrated that WWI significantly and positively correlated with all-cause and cardiovascular mortality in patients with MASLD. The association between WWI and mortality remained statistically significant after adjustment for multiple potential confounding variables. The Kaplan-Meier survival curve analysis demonstrated a significant increase in all-cause and cardiovascular mortality with increasing quartiles of WWI. The RCS analysis showed a linear dose-response relationship between WWI and mortality in patients with MASLD. Subgroup analyses revealed discrepancies in the predictive impact of WWI on mortality across different clinical characteristics, yet the overall trend remained consistent. CONCLUSIONS: The present study demonstrated that WWI is a valid indicator for assessing the degree of obesity and a significant predictor of prognosis in patients with MASLD. Higher WWI was found to be significantly associated with higher all-cause mortality and cardiovascular mortality in MASLD patients.

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