Association between blood pressure and metabolic dysfunction-associated fatty liver disease among adults without hypertension: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2017-2018.

Abstract

Objective: High blood pressure (BP) is one of the optional components of metabolic dysfunction-associated fatty liver disease (MAFLD). However, whether subclinical elevations in BP are related to MAFLD even in the absence of hypertension remains unclear. We investigated the association between BP and MAFLD among adults without hypertension.

Design and setting: A nationwide, multicentre and cross-sectional study of the National Health and Nutrition Examination Survey (NHANES).

Participants: 2022 US adults without hypertension were recruited in the 2017-2018 cycle of the NHANES.

Exposure: Systolic BP (SBP) and diastolic BP (DBP).

Outcome measures: MAFLD was defined by the novel consensus of diagnostic criteria in 2020.

Results: MAFLD is common among US adults even at the 'normal' BP ranges, with a prevalence of 38.8%. We observed a positive, linear relationship between SBP and MAFLD down to 90 mm Hg, and between DBP and MAFLD down to 50 mm Hg. The MAFLD risk was elevated significantly with increasing SBP level (per 10 mm Hg increase: adjusted OR, 1.59 (95% CI, 1.21 to 2.09)) in the range of 90-129 mm Hg. The relationship between DBP and MAFLD was not evident (per 10 mm Hg increase: adjusted OR, 1.42 (95% CI, 0.96 to 2.21)) in the range of 50-79 mm Hg. Similar findings were identified in the sensitivity analyses.

Conclusions: In a population without hypertension, SBP is significantly associated with MAFLD, indicating potential early intervention to prevent MAFLD.