ArticleFrontiers in endocrinology2026
Metabolic-dimension CKM staging and cardiometabolic components predict incident MASLD: a longitudinal community-based cohort study.
Article in Frontiers in endocrinology, 2026. 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
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) shares metabolic pathways with cardiovascular-kidney-metabolic (CKM) syndrome, but prospective community-based evidence linking CKM metabolic risk burden to incident MASLD remains limited. Methods: We analysed longitudinal health examination data from a community cohort in Guangxi, southern China. Because subclinical cardiovascular and kidney assessments were unavailable, CKM staging was operationalised as a metabolic-dimension staging system based on five cardiometabolic (CM) components. Cross-sectional analyses included 3,315 participants. The primary forward cohort included 2,055 participants free of MASLD at baseline, with 294 incident events over a median 2.61 years. An exploratory reverse cohort included 648 participants at CKM early stage, with 407 progression events over a median 1.77 years. Ultrasonographic fatty liver alone was used as a sensitivity outcome to address definitional overlap between MASLD and CM components. Results: Each additional CM component was associated with higher odds of prevalent MASLD (OR = 1.94, 95% CI: 1.79-2.10), with a similar estimate for fatty liver alone (OR = 1.90, 95% CI: 1.75-2.05). In the forward cohort, metabolic-dimension CKM Stage 2 was associated with higher incident MASLD risk compared with Stage 0 (HR = 2.33, 95% CI: 1.20-4.54), and the fatty-liver-alone sensitivity outcome yielded a consistent estimate (HR = 2.95, 95% CI: 1.39-6.26). Among individual CM components, excess adiposity was the strongest predictor (mutually adjusted HR = 2.97, 95% CI: 2.00-4.41), followed by hypertriglyceridaemia (HR = 1.63, 95% CI: 1.23-2.18). In the exploratory reverse cohort, baseline MASLD was associated with CKM stage progression in the age- and sex-adjusted model (HR = 2.13, 95% CI: 1.49-3.03), but this association attenuated after adjustment for baseline BMI (HR = 1.18, 95% CI: 0.81-1.71). Conclusion: Metabolic-dimension CKM staging and CM component burden predicted incident MASLD, with excess adiposity and
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