Metabolic-dimension CKM staging and cardiometabolic components predict incident MASLD: a longitudinal community-based...

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.

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.

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).

Metabolic-dimension CKM staging and CM component burden predicted incident MASLD, with excess adiposity and hypertriglyceridaemia as dominant component-level predictors. The forward association was robust to removing MASLD-CM definitional overlap. In contrast, baseline MASLD was not clearly associated with CKM stage progression after accounting for baseline adiposity and related metabolic severity.