Dose-response association between metabolic syndrome component count and metabolic dysfunction-associated fatty liver disease, and independent graded association of visceral fat area: a cross-sectional study in a health-checkup population.

OBJECTIVES

To quantify the dose-response association between metabolic syndrome (MetS) component count and metabolic dysfunction-associated fatty liver disease (MAFLD), and to evaluate the independent graded association of visceral fat area (VFA) with MAFLD.

MATERIALS AND

METHODS

This single-center cross-sectional study enrolled adults (≥18 years) undergoing routine health checkups from July 2024 to December 2025. MAFLD was defined according to the Chinese Guideline for the Prevention and Treatment of Metabolic Dysfunction-associated Fatty Liver Disease (Version 2024), based on imaging-confirmed fatty liver plus predefined metabolic criteria after exclusion of excessive alcohol consumption and other specific causes of fatty liver. MetS component count was categorized as 0, 1, 2, or ≥3, and VFA, measured by bioelectrical impedance, was analyzed in quartiles. Multivariable logistic regression estimated ORs (95% CI) using hierarchical models. Analyses were also performed in the normal-BMI subgroup, with discriminatory ability assessed by the area under the curve (AUC).

RESULTS

Among 7,192 participants (mean age 42.7 years; 51.9% men), 2,794 (38.8%) were classified as having MAFLD. MAFLD prevalence increased markedly with increasing metabolic syndrome (MetS) component count (0/1/2/≥3: 14.0, 25.8, 55.8, and 79.7%, respectively; P for trend < 0.001). In Model 2, compared with 0 components, the ORs (95% CIs) for MAFLD were 2.75 (2.22-3.41), 5.33 (4.24-6.71), and 10.26 (7.88-13.43) for 1, 2, and ≥3 components, respectively. In Model 3, which additionally included VFA quartiles, the association remained significant, with corresponding ORs (95% CIs) of 2.56 (2.06-3.18), 4.78 (3.79-6.04), and 9.23 (7.03-12.13). VFA also showed an independent graded association with MAFLD (Q4 vs. Q1: OR 3.27, 95% CI 2.44-4.39). Similar patterns were observed in the normal-BMI subgroup, where higher MetS component count remained strongly associated with MAFLD and VFA retained an independent graded association (Q4 vs. Q1: OR 3.67, 95% CI 2.12-6.36). The fully adjusted model showed good discrimination overall (AUC 0.887, 95% CI 0.879-0.895).

CONCLUSION

MetS component count showed a clear dose-response association with MAFLD, while VFA showed an independent graded association. These findings support the integration of cumulative metabolic burden and visceral adiposity into MAFLD-oriented risk stratification in routine health screening.