Elevated serum parathyroid hormone predicts metabolic dysfunction-associated steatotic liver disease (MASLD) and progressive fibrosis.

Abstract

Background and aim: Insufficient researches have been conducted on the correlation between serum parathyroid hormone (PTH) levels and metabolic dysfunction-associated steatotic liver disease (MASLD), as well as the risk for advanced fibrosis. The objective of this research was to investigate the potential association between serum PTH and both MASLD and progressive fibrosis.

Methods and results: A cross-sectional study utilized the datasets obtained from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2003-2006 (n = 1318). The reason we chose data from this time period is that the NHANES database only contains parathyroid hormone indicators for these two survey cycles. MASLD was defined with two noninvasive indexes, namely hepatic steatosis index (HSI) and fatty liver index (FLI), corresponding to MASLD _HSI and MASLD _FLI respectively. Advanced fibrosis was evaluated with MASLD fibrosis score (MFS). We investigated the independent interaction between serum PTH and MASLD or advanced fibrosis using weighted multivariable logistic regression analysis, restricted cubic spline models, subgroup analysis and mediation analysis. Multivariable logistic regression showed that adults in the medium and high serum PTH tertiles were associated with increased values of MASLD-related indices (such as FLI, HSI and MFS) [(MASLD _HSI: OR [95 % CI], 3.16 [1.83, 5.47] and 3.97 [2.13, 7.39]; MASLD _FLI: OR [95 % CI], 2.87 [1.63, 5.06] and 4.12 [2.20, 7.74]; MFS: OR [95 % CI], 2.55 [1.14, 5.69] and 2.20 [1.11, 4.36])]. Subgroup analysis showed that these associations were more evident in subjects at middle-age, hypertension and without physical exertion (MASLD _HSI: only middle-age; MASLD _FLI: middle-age and hypertension; MFS: without physical activity; all P < 0.05). Furthermore, mediation analysis revealed that BMI and HOMA-IR mediated the link between serum PTH and MASLD (defined by HSI and FLI) or advanced fibrosis (MFS) in adults.

Conclusions: In the U.S. general population, elevated PTH level is strongly associated with MASLD or advanced fibrosis and can serve as a reliable indicator in both diseases. Therefore, a high serum PTH level may predispose people to MASLD or advanced fibrosis morbidity.