Longitudinal Changes in Physical Performance with Metabolic Dysfunction-Associated Steatotic Liver Disease and Coronary Artery Disease

Background: Physical performance provides valuable insights into metabolic and cardiovascular health, particularly regarding metabolic dysfunction-associated steatotic liver disease (MASLD) and coronary artery disease (CAD). Objective: This study examined the relationship between longitudinal changes in physical performance, assessed using the Timed Up and Go (TUG) test, and indicators of MASLD, CAD, and body fat distribution over time. Methods: This 3-year longitudinal prospective cohort study included 1,096 older adults. Participants underwent baseline and follow-up assessments. Based on TUG results, participants were categorized into four groups: Normal→Normal (Group 1), Impaired→Normal (Group 2), Normal→Impaired (Group 3), and Impaired→Impaired (Group 4). MASLD indicators (Fibrosis-4 index [FIB-4], MASLD liver fat score, and hepatic steatosis index [HSI]), CAD indicators (coronary artery calcium [CAC] and coronary artery volume [CAV] scores), and body fat distribution (L3 cross-sectional visceral fat area [L3VFA], L3 cross-sectional subcutaneous fat area [L3SFA], and visceral-to-subcutaneous fat ratio [VSR]) were also analyzed. Results: At baseline, groups with impaired TUG exhibited worse MASLD, CAD, and fat distribution profiles. Longitudinally, within-group analyses revealed distinct trajectories based on TUG changes over 3 years. For MASLD, the FIB-4 index significantly increased in participants whose TUG declined from normal to impaired (Group 3) or remained persistently impaired (Group 4)(p<0.05). For CAD, CAC and CAV scores increased significantly across all four groups (p<0.001). Regarding fat distribution, subcutaneous fat (L3SFA) significantly increased in Groups 3 and 4. Additionally, the proportion of individuals with high visceral fat (VFA ≥160 cm²) increased in these impaired groups, whereas it decreased in those who maintained or improved to a normal TUG (Groups 1 and 2). Conclusion: Baseline TUG impairment and within-group longitudinal TUG deterioration were associated with adverse MASLD, CAD, and fat distribution profiles. While causal relationships cannot be established, TUG performance may serve as a functional marker reflecting metabolic and cardiovascular health status in older adults.