Association of Metabolic Dysfunction–Associated Steatotic Liver Disease With Features of Cerebral Small‐Vessel Disease on Magnetic Resonance Images: A Large Cross‐Sectional Study

Background We examined the associations between metabolic dysfunction–associated steatotic liver disease (MASLD) and cerebral small‐vessel disease burden manifested on magnetic resonance images in a population of Chinese individuals undergoing a healthy checkup. Methods In this cross‐sectional study, 7679 participants (aged ≥18 years) with brain magnetic resonance imaging data from Hunan Province, China, were enrolled between 2017 and 2023. The cerebral small‐vessel disease burden was measured using markers on magnetic resonance images, including total white matter hyperintensity (WMH), 4 WMH spatial patterns (deep WMH, periventricular, juxtacortical WMH, and juxtaventricular WMH), lacunes, cerebral microbleeds, and enlarged perivascular space. Multiple linear and ordinal/binary logistic regression models were used for liver–brain associations, and separate models were created for subgroup analyses. The role of cardiovascular metabolism–related mediators was estimated using mediation analysis. Results MASLD was significantly associated with a greater volume of total WMH (including 2 unique spatial patterns: deep WMH and periventricular WMH) and a greater burden of lacunes. The relationships between MASLD and cerebral microbleeds or enlarged perivascular space were not significant. Stratified analyses revealed that the liver–brain association (MASLD and total WMH volume or lacunar lesions) was affected by hypertension ( P ‐interaction <0.05). Moreover, blood pressure had the greatest mediating effect among cardiovascular metabolic risks. The mediation proportions with SBP and DBP were 11.67% and 12.67%, respectively, for total WMH volume and 12.37% and 10.87%, respectively, for lacunes. Conclusions Our study revealed a close link between MASLD and cerebral small‐vessel disease in terms of neuroimaging features. Individuals with MASLD, especially those accompanied by hypertension, should be encouraged to undergo screening for cerebral small‐vessel disease risk to facilitate the prediction of brain aging burden.