Cardiometabolic multimorbidity trajectories and incident non-steatotic chronic liver disease in middle-aged and older adults.

BACKGROUND AND AIMS: Cardiometabolic multimorbidity (CMM) may increase the risk of chronic liver disease, but evidence on non-steatotic chronic liver disease (NSCLD) remains limited.

METHODS AND

RESULTS

We used data from the China Health and Retirement Longitudinal Study and included adults aged 45 years or older. Participants were classified into 4 mutually exclusive CMM trajectory groups: H→M, H→C, H→M→CMM, and H→C→CMM. Cox proportional hazards models were used to examine the associations between CMM trajectories and incident NSCLD. Potential heterogeneity by percent predicted peak expiratory flow (PEF% predicted) and the potential mediating role of frailty were further assessed. Among 8310 participants, incident NSCLD increased across trajectory groups from 6.36% in H→M to 15.43% in H→C→CMM; frailty prevalence increased from 16.98% to 32.20% (both P < 0.001). Kaplan-Meier curves differed significantly across trajectories (log-rank P < 0.0001). Associations varied by PEF% predicted (adjusted P for interaction = 0.0025). In the low PEF% predicted stratum, adjusted HRs were 2.48 for H→C, 1.99 for H→M→CMM, and 2.34 for H→C→CMM versus H→M. Frailty mediated 4.82% of the observed association.

CONCLUSIONS

CMM trajectories were associated with incident NSCLD in middle-aged and older adults. These associations varied by respiratory function and appeared stronger in participants with lower PEF% predicted. Frailty accounted for a modest proportion of the observed association.