Association between FIB-4 index and lower extremity arterial disease in MASLD patients: a cross-sectional study

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an elevated risk of cardiovascular conditions, such as lower extremity arterial disease (LEAD). The Fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis, may have predictive value for LEAD in patients with MASLD. This study aimed to explore the association between FIB-4 and LEAD in a cohort of patients with MASLD.

This cross-sectional study included 481 participants with MASLD, selected from a comprehensive health check-up database. Participants were categorized into three groups based on their FIB-4 index (< 1.3, 1.3-2.66, > 2.66) and underwent duplex ultrasonography to diagnose LEAD. Logistic regression models were employed to evaluate the association between FIB-4 and LEAD, adjusting for demographic, metabolic, and lipid-related factors. Subgroup analyses were performed by sex, age, diabetes mellitus status, hypertension, dyslipidemia, smoking status.

The prevalence of LEAD increased with FIB-4 levels, from 51.3% in the low FIB-4 group to 86.5% in the high FIB-4 group (p < 0.001). In fully adjusted models, higher FIB-4 levels were significantly associated with LEAD (adjusted odds ratio [OR]: 3.54, 95% confidence interval [CI]: 1.39-9.01) in the high FIB-4 group compared to the low group. As a continuous variable, each unit increase in FIB-4 was associated with a 66% higher likelihood of LEAD (adjusted OR: 1.66, 95% CI: 1.12-2.26, P < 0.001). Subgroup analyses did not reveal significant interactions (P for interaction > 0.05).

Higher FIB-4 levels are independently associated with the prevalence of LEAD in MASLD patients, although subgroup analyses did not reveal significant interactions. This suggests that further studies with larger sample sizes are needed to explore these relationships more comprehensively.