Lifestyle Mediates the Affiliation Between Normal-Weight Visceral Weight problems and MASLD in Older Adults with Hypertension and Diabetes

Abstract

Objective
Older adults with coexisting hypertension and sort 2 diabetes are at excessive danger for metabolic dysfunction-associated steatotic liver illness (MASLD). Normal-weight visceral weight problems (NWVO)—extra visceral fats regardless of regular physique mass index and waist circumference—is an neglected danger issue. Lifestyle is modifiable, however its function in explaining the NWVO-MASLD affiliation is unknown. We quantified the proportion of this affiliation statistically mediated by unhealthy way of life patterns.
Methods
This retrospective cohort examine included 26,289 adults aged ≥50 years with hypertension and sort 2 diabetes from the Shenzhen National Basic Public Health Services Program (2010–2023). NWVO was outlined utilizing the Chinese Visceral Adiposity Index alongside regular physique dimension standards. MASLD was identified by ultrasound and cardiometabolic standards. A composite way of life rating (bodily exercise, alcohol, smoking, dietary salt consumption) was derived. We utilized the generalized front-door method for causal mediation evaluation to estimate the path-specific impact of NWVO on MASLD incidence defined by way of life, sturdy to unmeasured confounding.
Results
Over a imply 5.5-year follow-up, NWVO was related to a considerably elevated MASLD danger (adjusted HR: 1.82, 95% CI: 1.76, 1.89). NWVO was related to a 2.35-fold greater danger of getting an unhealthy way of life (2.25, 2.44), which in flip elevated MASLD danger by 11.2% (8.7, 13.8). Unhealthy way of life statistically defined 19.8% (12.1, 33.6) of the entire NWVO-MASLD impact, similar to a mediated danger enhance of 41.2% (3.5, 92.7).
Conclusion
In this multimorbid older inhabitants, NWVO is a major MASLD danger issue, and modifiable way of life patterns account for roughly one-fifth of this affiliation. Our findings help integrating visceral adiposity evaluation into routine care and implementing multifaceted way of life interventions—concentrating on weight loss program, bodily exercise, and substance use—to scale back the burden of MASLD in growing older populations with metabolic comorbidities.