Gastro Hep Advances · Published 2026-01-01 · DOI 10.1016/j.gastha.2026.100988
Background and Aims: Cardiovascular screening largely relies on anthropometric metrics and overlooks normal-weight individuals with metabolic dysfunction, particularly those with steatotic liver disease (SLD). This gap may leave a substantially high-risk population undetected. Therefore, this study assessed the prevalence of cardiovascular disease (CVD) across 4 distinct metabolic phenotypes defined by body mass index (BMI) and hepatic steatosis status. Methods: We analyzed 34,848 Japanese adults enrolled in a community health screening program (2007–2010). Participants were classified into 4 metabolic phenotypes based on BMI and steatosis using the fatty liver index. The primary outcome was prevalent CVD. Logistic regression and machine learning models were used to compare the cardiovascular risk across phenotypes. Results: Normal-weight individuals with SLD (NWSLD; n = 496, 1.4%) demonstrated the highest CVD prevalence (3.63%) vs healthy controls (0.72%) and obese individuals with SLD (1.76%). After multivariable adjustment, NWSLD remained strongly associated with CVD (odds ratio: 3.63; 95% confidence interval: 2.11–5.88; P < .001). Incorporating NWSLD improved prediction over BMI-based models (C-statistic 0.790 vs 0.781; P < .001) and showed favorable clinical efficiency (number needed to treat = 34). Conclusion: NWSLD represents an unrecognized yet highly vulnerable cardiovascular phenotype, challenging BMI-centric risk assessment and supporting metabolic-based precision screening.
Abstract from DOAJ. Public domain (CC0 1.0).
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