Associations between metabolic dysfunction-associated fatty liver disease and carotid and femoral atherosclerosis: a population-based cross-sectional study.

BACKGROUND: The associations between metabolic dysfunction-associated fatty liver disease (MAFLD) and its subtypes (diabetes mellitus [DM]-MAFLD, overweight [OW]-MAFLD, and lean MAFLD) with carotid and femoral atherosclerosis are not well understood in the Chinese population. METHODS: This prospective study included participants from southeast China aged between 35-75 years. MAFLD and its subtypes, bilateral carotid and femoral intima-media thickness (CIMT, FIMT, and IMT), plaque (CP, FP, and Plaque), and atherosclerosis (CAS, FAS, and AS), were assessed using ultrasound imaging. Multivariate logistic regression analysis was used to evaluate these associations through odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). RESULTS: A total of 5392 participants (1695 [31.4%] male) with a mean age of 55.6 ± 9.9 years were included in this study. The prevalence of CIMT, CP, CAS, FIMT, FP, FAS, IMT, plaque, and AS in the MAFLD group were 12.0%, 9.3%, 16.0%, 10.8%, 6.3%, 13.4%, 16.7%, 11.9%, and 20.8%, respectively, which were higher than that in the non-MAFLD group. After adjusting for possible confounds, CIMT was significantly associated with MAFLD (1.25[1.04, 1.50]) and DM-MAFLD (1.47[1.15, 1.89]); CP was associated with MAFLD (1.23[1.01, 1.50]) and DM-MAFLD (1.44 [1.10, 1.89]); CAS was associated with MAFLD (1.29[1.10, 1.53]) and DM-MAFLD (1.60[1.27, 2.00]); FP was associated with MAFLD (1.28[1.01, 1.63]) and DM-MAFLD (1.49[1.08, 2.05]); and plaque was associated with MAFLD (1.22[1.01, 1.46]) and DM-MAFLD (1.48[1.15, 1.89]) (P < 0.05). IMT and AS were associated with DM-MAFLD, with ORs (1.29[1.03, 1.62]) and (1.38[1.11, 1.71]), respectively (P < 0.05). These associations were more profound in male participants, those with < 7 years of education, used medication, and were smokers (P < 0.05). CONCLUSIONS: MAFLD, especially DM-MAFLD, may increase the risk of atherosclerosis (particularly in the carotid arteries). Furthermore, individual and lifestyle factors may further affect this risk.