Gender-specific associations between metabolic dysfunction-associated fatty liver disease with atherosclerosis, inflammation, and eating habits

Abstract

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) has multifactorial pathogenesis. Given its close relationship with dietary habits, and the need for improved geographical representation and sex discrimination, we explored the relationship between MAFLD with eating habits, systemic inflammation, and coronary atherosclerosis within a Latin American cohort.

Methods: We included asymptomatic subjects between 30 and 75 years old who underwent a non-contrast, ECG-gated cardiac CT. The presence of MAFLD was defined as hepatic steatosis and at least one of: overweight/obesity, type 2 diabetes mellitus, or evidence of metabolic dysregulation. We also evaluated coronary artery calcification (CAC), laboratory, ECG, and cardiac chamber dimensions.

Results: We included 799 patients (mean age 57.4 ± 10.4). Both men and women with MAFLD showed higher HbA1C (p < 0.0001) and triglyceride (p < 0.0001), and lower HDL-C (p < 0.01) levels, and larger cardiac chambers (p < 0.0001); whereas MAFLD was associated with hs-CRP levels (p < 0.0001), CAC (p < 0.01), heart rate (p = 0.002), longer QRS duration (p < 0.01) only among women. Dietary habits related to MAFLD included processed meat (p < 0.01), meat (p < 0.05), sugar-free soft beverages (p < 0.0001), and soft beverages (p < 0.01) among women, whereas men with MAFLD showed lower dairy product consumption (p < 0.01). At multivariate analysis, age (p < 0.0001), BMI (p < 0.01), HbA1C, total cholesterol, triglyceride, and LDL-C levels (all p < 0.0001), processed meat (p < 0.01), and sugar-free soft beverages (p < 0.05) were independently associated with MAFLD in women; and age (p < 0.01), BMI (p < 0.0001), HbA1C (p < 0.05), and triglycerides (p < 0.0001) in men.

Conclusions: In this comprehensive Latin American cohort of asymptomatic subjects, we identified a more consistent relationship between MAFLD and a worsening cardiometabolic phenotype among women.