{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:08:47Z","timestamp":1789711727778,"version":"4.0.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Aim<\/jats:title>\n To examine the associations of cardiometabolic burden with transitions from CVD-free status to incident CVD, death without prior CVD, and death after CVD among individuals with MASLD, and to further characterize non-linear patterns, temporal variations, and potential contributing factors related to these associations.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This prospective cohort analysis included 72,922 UK adults with MASLD. Cardiometabolic burden was primarily assessed by the number of cardiometabolic risk factors, with an internally derived weighted score evaluated as a complementary secondary measure. Traditional Cox models estimated overall associations with incident CVD and death, whereas multistate models quantified transition-specific associations. Penalised splines assessed non-linearity, piecewise Cox models evaluated time-stratified associations, and mediation analyses examined inflammatory and lifestyle-related factors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Over a median follow-up of 15.9\u202fyears, 15,352 participants developed CVD, 4,273 died without prior CVD, and 4,228 died after incident CVD. Each additional cardiometabolic risk factor was associated with higher risks of the baseline-to-CVD, baseline-to-death, and CVD-to-death transitions (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.15\u20131.19; HR 1.09, 95% CI 1.06\u20131.13; and HR 1.13, 95% CI 1.10\u20131.17, respectively). Corresponding estimates per 1-standard deviation increase in the weighted score were HR 1.23 (95% CI 1.20\u20131.25), HR 1.12 (95% CI 1.08\u20131.16), and HR 1.19 (95% CI 1.15\u20131.23), respectively. Associations with incident CVD were stronger during early follow-up, whereas death-related associations became more apparent over longer follow-up. Significant age interactions were observed, with stronger associations among participants aged &lt;60\u202fyears (P for interaction &lt;0.05). In mediation analyses, estimated indirect proportions were generally &lt;3% for circulating inflammatory markers and were larger for smoking and drinking status.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Among individuals with MASLD, greater cardiometabolic burden was associated with all disease-state transitions, most strongly with incident CVD. Death-related associations became more apparent over longer follow-up, supporting sustained cardiometabolic surveillance. Associations were more pronounced in younger participants, suggesting that individuals under 60\u202fyears with high cardiometabolic burden may be\n a priori<\/jats:italic>\n ty subgroup for earlier identification and transition-specific risk assessment.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1928761","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:20Z","timestamp":1789709780000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of cardiometabolic burden with cardiovascular disease\u2013death transitions in metabolic dysfunction-associated steatotic liver disease: a prospective cohort study using multistate analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Chuanyong","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangji","family":"Zhang","sequence":"additional","affiliation":[{"name":"Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University","place":["Hangzhou, China"]},{"name":"School of Basic Medical Sciences, Zhejiang Chinese Medical University","place":["Hangzhou, China"]},{"name":"Zhejiang Engineering Research Center for \"Preventive Treatment\" Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongyan","family":"Du","sequence":"additional","affiliation":[{"name":"Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University","place":["Hangzhou, China"]},{"name":"School of Basic Medical Sciences, Zhejiang Chinese Medical University","place":["Hangzhou, China"]},{"name":"Zhejiang Engineering Research Center for \"Preventive Treatment\" Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenke","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]},{"name":"Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University","place":["Hangzhou, China"]},{"name":"School of Life Science, Anhui Provincial Key Laboratory of Tumor Evolution and Intelligent Diagnosis and Treatment, Anhui Province Key Laboratory of Immunology in Chronic Diseases, Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1053\/j.gastro.2019.11.312","article-title":"MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease","volume":"158","author":"Eslam","year":"2020","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1542","DOI":"10.1016\/j.jhep.2023.06.003","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Rinella","year":"2023","journal-title":"J Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.tem.2024.02.007","article-title":"Current status and future trends of the global burden of MASLD","volume":"35","author":"Miao","year":"2024","journal-title":"Trends Endocrinol 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