ArticleScientific reports2025
CUN‑BAE predicts risk of metabolic dysfunction-associated steatotic liver disease: A prospective cohort study in non‑obese Chinese adults.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
While metabolic dysfunction-associated steatotic liver disease (MASLD) increasingly affects non-obese individuals, current screening approaches show poor performance in this population. We investigated whether the Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) could better identify MASLD risk than traditional measures in non-obese adults, and examined how the triglyceride-glucose (TyG) index might mediate this relationship. Using data from the Dryad public database, we followed 16,173 Chinese non-obese adults (BMI < 25 kg/m²) without baseline MASLD for 5 years. MASLD diagnosis relied on abdominal ultrasonography. We applied multivariable logistic regression to assess cross-sectional associations and Cox models for incident disease risk. Restricted cubic splines revealed dose-response patterns in sex-stratified analyses, while structural equation modeling quantified TyG index mediation effects. Our cohort included 8,483 men and 7,690 women. After full adjustment, each standard deviation increased in CUN-BAE linked to 35% higher MASLD risk (HR = 1.35, 95% CI: 1.29-1.41, P < 0.001). Comparing top versus bottom tertiles showed 95% increased risk (HR = 1.95, 95% CI: 1.74-2.18, P < 0.001). Five-year cumulative incidence rose from 8.4% (lowest tertile) to 15.8% (middle) to 18.9% (highest tertile, Log-rank P < 0.0001). Cubic spline analysis uncovered sex differences: women showed a sharp risk increase above CUN-BAE 31.2, while men displayed more gradual, linear patterns. The TyG index accounted for 24.7% of the CUN-BAE-MASLD association (P < 0.001). CUN-BAE effectively predicts MASLD development in Chinese non-obese adults through clear dose-response relationships that differ by sex. Since TyG index only partially explains this association, insulin resistance appears important but insufficient to account for the full relationship. CUN-BAE could serve as a practical screening tool to identify high-risk individuals missed by conventional BMI-based approaches, enabling more precise risk stratification in non-obese populations.
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