Metabolic dysfunction-associated fatty liver disease and risk of hypertension in young adults: A cross-sectional study mediated by inflammatory markers.

OBJECTIVE

This study aimed to investigate the prevalence of hypertension among young adults with MAFLD, assess the association between the presence and severity of MAFLD and hypertension, and explore potential mediating mechanisms linking MAFLD and hypertension in this population.

METHODS

A total of 5,327 individuals aged 18-45 years from the National Health and Nutrition Examination Survey (2017-2023) were included. Multivariable logistic regression analysis was performed to evaluate the independent associations of MAFLD and its severity with hypertension and isolated diastolic hypertension. Mediation analysis assessed the mediating effects of inflammatory markers, including white blood cell (WBC) count, neutrophil count, and systemic immune-inflammation index (SII).

RESULTS

The prevalence of MAFLD in the study population was 44.05%. Hypertension prevalence in the MAFLD group was significantly higher than in the non-MAFLD group (37.68% vs. 15.19%, P < 0.001). After adjusting for sex, age, race, alcohol consumption, and comorbidities such as diabetes and renal insufficiency, individuals with MAFLD and moderate-to-severe fibrosis exhibited a significantly higher risk of hypertension compared to non-MAFLD individuals (OR = 3.414, 95% CI: 2.522-4.622), P < 0.001). Mediation analysis demonstrated that WBC, neutrophils, and SII mediated 7.62% (95% CI: 2.75-15.00), 6.71% (95% CI: 2.48-12.65), and 5.90% (95% CI: 2.40-10.88) of the association between MAFLD and hypertension, respectively.

CONCLUSION

MAFLD, particularly in the presence of advanced liver fibrosis, is strongly and independently associated with hypertension in young adults. Systemic inflammation acts as a key mediator in this relationship, highlighting its potential as a therapeutic target for precision antihypertensive strategies in this population.