Metabolic dysfunction-associated steatotic liver disease and arterial stiffness by body mass index: the Kailuan Study

Background and Aim Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with arterial stiffness, but whether this association differs across body mass index (BMI) phenotypes remains uncertain. We examined the associations of lean, overweight, and obese MASLD with baseline brachial-ankle pulse wave velocity (baPWV), annual baPWV progression, and incident elevated baPWV (≥ 1800 cm/s). Methods and Results Among Kailuan participants undergoing their first baPWV assessment during 2010–2019, 39 541 were included in the cross-sectional analysis, 21 205 in the progression analysis, and 18 310 in the incident elevated baPWV analysis. Multivariable linear regression was used for baseline baPWV and progression, and Poisson regression with follow-up time as an offset was used for incident elevated baPWV. Compared with participants without MASLD, all three MASLD phenotypes were associated with higher baseline baPWV, faster progression, and a higher incidence of elevated baPWV. Adjusted differences ranged from 58.80 to 92.68 cm/s for baseline baPWV and from 6.19 to 10.73 cm/s/year for progression, while incidence rate ratios ranged from 1.45 to 1.64. Significant heterogeneity across BMI categories was observed for baseline baPWV, with larger differences in lean MASLD, whereas no significant heterogeneity was observed for progression or incident elevated baPWV. Conclusions MASLD was associated with an adverse arterial stiffness profile across BMI phenotypes. Normal BMI did not preclude an unfavorable arterial stiffness profile in MASLD, and differences across BMI phenotypes varied by outcome.