{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:14:10Z","timestamp":1789593250459,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify the dose\u2013response association between metabolic syndrome (MetS) component count and metabolic dysfunction-associated fatty liver disease (MAFLD), and to evaluate the independent graded association of visceral fat area (VFA) with MAFLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This single-center cross-sectional study enrolled adults (\u226518\u202fyears) undergoing routine health checkups from July 2024 to December 2025. MAFLD was defined according to the Chinese Guideline for the Prevention and Treatment of Metabolic Dysfunction-associated Fatty Liver Disease (Version 2024), based on imaging-confirmed fatty liver plus predefined metabolic criteria after exclusion of excessive alcohol consumption and other specific causes of fatty liver. MetS component count was categorized as 0, 1, 2, or \u22653, and VFA, measured by bioelectrical impedance, was analyzed in quartiles. Multivariable logistic regression estimated ORs (95% CI) using hierarchical models. Analyses were also performed in the normal-BMI subgroup, with discriminatory ability assessed by the area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 7,192 participants (mean age 42.7\u202fyears; 51.9% men), 2,794 (38.8%) were classified as having MAFLD. MAFLD prevalence increased markedly with increasing metabolic syndrome (MetS) component count (0\/1\/2\/\u22653: 14.0, 25.8, 55.8, and 79.7%, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      for trend &amp;lt; 0.001). In Model 2, compared with 0 components, the ORs (95% CIs) for MAFLD were 2.75 (2.22\u20133.41), 5.33 (4.24\u20136.71), and 10.26 (7.88\u201313.43) for 1, 2, and \u22653 components, respectively. In Model 3, which additionally included VFA quartiles, the association remained significant, with corresponding ORs (95% CIs) of 2.56 (2.06\u20133.18), 4.78 (3.79\u20136.04), and 9.23 (7.03\u201312.13). VFA also showed an independent graded association with MAFLD (Q4 vs. Q1: OR 3.27, 95% CI 2.44\u20134.39). Similar patterns were observed in the normal-BMI subgroup, where higher MetS component count remained strongly associated with MAFLD and VFA retained an independent graded association (Q4 vs. Q1: OR 3.67, 95% CI 2.12\u20136.36). The fully adjusted model showed good discrimination overall (AUC 0.887, 95% CI 0.879\u20130.895).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MetS component count showed a clear dose\u2013response association with MAFLD, while VFA showed an independent graded association. These findings support the integration of cumulative metabolic burden and visceral adiposity into MAFLD-oriented risk stratification in routine health screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1842607","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:38:58Z","timestamp":1781588338000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Dose\u2013response association between metabolic syndrome component count and metabolic dysfunction-associated fatty liver disease, and independent graded association of visceral fat area: a cross-sectional study in a health-checkup population"],"prefix":"10.3389","volume":"14","author":[{"given":"Qian","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunmao","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Special Medicine, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.jhep.2020.03.039","article-title":"A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement","volume":"73","author":"Eslam","year":"2020","journal-title":"J Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"972","DOI":"10.14218\/jcth.2021.00201","article-title":"Epidemiology and clinical outcomes of metabolic (dysfunction)-associated fatty liver disease","volume":"9","author":"Lin","year":"2021","journal-title":"J Clin Transl Hepatol"},{"key":"ref3","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":"ref4","doi-asserted-by":"publisher","first-page":"7083","DOI":"10.1038\/s41598-025-91312-5","article-title":"Global burden of Mafld, Mafld related cirrhosis and mash related liver Cancer from 1990 to 2021","volume":"15","author":"Guo","year":"2025","journal-title":"Sci Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"8263","DOI":"10.3748\/wjg.v23.i47.8263","article-title":"Clinical epidemiology and disease burden of nonalcoholic fatty liver disease","volume":"23","author":"Perumpail","year":"2017","journal-title":"World J Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.1161\/circulationaha.105.169404","article-title":"Diagnosis and Management of the Metabolic Syndrome: an American Heart Association\/National Heart, Lung, and Blood Institute scientific statement","volume":"112","author":"Grundy","year":"2005","journal-title":"Circulation"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1355732","DOI":"10.3389\/fnut.2024.1355732","article-title":"Metabolic dysfunction-associated fatty liver disease: current therapeutic strategies","volume":"11","author":"Al Hashmi","year":"2024","journal-title":"Front Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/j.tem.2021.04.008","article-title":"Links between metabolic syndrome and metabolic dysfunction-associated fatty liver disease","volume":"32","author":"Lim","year":"2021","journal-title":"Trends Endocrinol Metab"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12933-021-01215-8","article-title":"Cumulative burden of metabolic syndrome and its components on the risk of atrial fibrillation: a Nationwide population-based study","volume":"20","author":"Ahn","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3031","DOI":"10.1111\/liv.16086","article-title":"Metabolic syndrome traits differentially and cumulatively influence Micro- and macrovascular disease risk in patients with Masld","volume":"44","author":"Henney","year":"2024","journal-title":"Liver Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1002\/cld.1183","article-title":"Nonalcoholic fatty liver disease: the role of visceral adipose tissue","volume":"19","author":"Hanlon","year":"2022","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1016\/j.jhep.2021.12.012","article-title":"Macrophage scavenger receptor 1 mediates lipid-induced inflammation in non-alcoholic fatty liver disease","volume":"76","author":"Govaere","year":"2022","journal-title":"J Hepatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.3390\/nu16132160","article-title":"Usefulness of body fat and visceral fat determined by Bioimpedanciometry versus body mass index and waist circumference in predicting elevated values of different risk scales for non-alcoholic fatty liver disease","volume":"16","author":"Gordito Soler","year":"2024","journal-title":"Nutrients"},{"key":"ref14","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":"ref15","doi-asserted-by":"publisher","first-page":"955","DOI":"10.14218\/jcth.2024.00311","article-title":"Guideline for the prevention and treatment of metabolic dysfunction-associated fatty liver disease (version 2024)","volume":"12","author":"Fan","year":"2024","journal-title":"J Clin Transl Hepatol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3275","DOI":"10.3390\/nu16193275","article-title":"Association between remnant cholesterol and metabolic syndrome among Chinese adults: Chinese nutrition and health surveillance (2015-2017)","volume":"16","author":"Li","year":"2024","journal-title":"Nutrients"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3503","DOI":"10.3390\/diagnostics13233503","article-title":"An optimized strategy based on conventional ultrasound for diagnosing metabolic dysfunction-associated Steatotic liver disease","volume":"13","author":"Feng","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"90","DOI":"10.12290\/xhyxzz.2024-0918","article-title":"Chinese guidelines for the clinical Management of Obesity (2024 edition)","volume":"16","year":"2025","journal-title":"Med J Peking Union Med College Hospital"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1136\/bmj.333.7564.362","article-title":"Overweight and obesity in China","volume":"333","author":"Wu","year":"2006","journal-title":"BMJ"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e056260","DOI":"10.1136\/bmjopen-2021-056260","article-title":"Gender-specific prevalence of metabolic-associated fatty liver disease among government employees in Tianjin, China: a cross-sectional study","volume":"11","author":"Huang","year":"2021","journal-title":"BMJ Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s12072-024-10774-3","article-title":"The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease","volume":"19","author":"Eslam","year":"2025","journal-title":"Hepatol Int"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"270","DOI":"10.3390\/antiox10020270","article-title":"Mechanisms of non-alcoholic fatty liver disease in the metabolic syndrome. A narrative review","volume":"10","author":"Rinaldi","year":"2021","journal-title":"Antioxidants (Basel)"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1007\/s00125-024-06196-3","article-title":"EASL\u2013EASD\u2013EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD): executive summary","volume":"67","author":"Tacke","year":"2024","journal-title":"Diabetologia"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/hep.0000000000000323","article-title":"Aasld practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1111\/j.1440-1746.2007.05212.x","article-title":"Visceral adipose tissue area is an independent risk factor for hepatic steatosis","volume":"23","author":"Park","year":"2008","journal-title":"J Gastroenterol Hepatol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/j.numecd.2022.01.009","article-title":"Visceral adipose tissue quality was associated with nonalcoholic fatty liver disease, independent of its quantity","volume":"32","author":"Igarashi","year":"2022","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.ecl.2023.01.003","article-title":"Lipid disorders and metabolic-associated fatty liver disease","volume":"52","author":"Anwar","year":"2023","journal-title":"Endocrinol Metab Clin N Am"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1002\/oby.23177","article-title":"Association of visceral adipose tissue and insulin resistance with incident metabolic syndrome independent of obesity status: the Iras family study","volume":"29","author":"Mongraw-Chaffin","year":"2021","journal-title":"Obesity (Silver Spring)"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2560-9.e15","DOI":"10.1016\/j.cgh.2022.09.028","article-title":"The Spectrum and impact of metabolic dysfunction in MAFLD: a longitudinal cohort analysis of 32,683 overweight and obese individuals","volume":"21","author":"Chan","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.metabol.2015.12.012","article-title":"The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD)","volume":"65","author":"Buzzetti","year":"2016","journal-title":"Metabolism"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"660179","DOI":"10.3389\/fimmu.2021.660179","article-title":"The role of the gut-liver Axis in metabolic dysfunction-associated fatty liver disease","volume":"12","author":"Mart\u00edn-Mateos","year":"2021","journal-title":"Front Immunol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/s2213-8587(19)30084-1","article-title":"Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement","volume":"7","author":"Neeland","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s12944-022-01763-2","article-title":"Gender differences in the ideal cutoffs of visceral fat area for predicting MAFLD in China","volume":"21","author":"Yu","year":"2022","journal-title":"Lipids Health Dis"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1089\/ars.2021.0044","article-title":"Sex differences in nonalcoholic fatty liver disease: estrogen influence on the liver-adipose tissue crosstalk","volume":"35","author":"Mor\u00e1n-Costoya","year":"2021","journal-title":"Antioxid Redox Signal"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1016\/j.dld.2024.05.003","article-title":"Age at menopause and risk of metabolic dysfunction-associated fatty liver disease: a 14-year cohort study","volume":"56","author":"Kim","year":"2024","journal-title":"Dig Liver Dis"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"4765","DOI":"10.3390\/nu15224765","article-title":"Unraveling the connection between fatty liver severity with gender, lifestyle, and health risks among workers","volume":"15","author":"Tang","year":"2023","journal-title":"Nutrients"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12944-025-02482-0","article-title":"Association between visceral fat area and metabolic syndrome in individuals with Normal body weight: insights from a Chinese health screening dataset","volume":"24","author":"Sun","year":"2025","journal-title":"Lipids Health Dis"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1002\/hep.24452","article-title":"Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a Meta-analysis","volume":"54","author":"Hernaez","year":"2011","journal-title":"Hepatology"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"290","DOI":"10.3350\/cmh.2017.0042","article-title":"Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification","volume":"23","author":"Lee","year":"2017","journal-title":"Clin Mol Hepatol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e036335","DOI":"10.1136\/bmjopen-2019-036335","article-title":"Comparison of visceral fat area measured by Ct and bioelectrical impedance analysis in Chinese patients with gastric Cancer: a cross-sectional study","volume":"10","author":"Gao","year":"2020","journal-title":"BMJ Open"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1002\/oby.22712","article-title":"Magnetic resonance imaging and bioelectrical impedance analysis to assess visceral and abdominal adipose tissue","volume":"28","author":"Chaudry","year":"2020","journal-title":"Obesity (Silver Spring)"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1842607\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:39:02Z","timestamp":1781588342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1842607\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2026.1842607"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1842607","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]},"article-number":"1842607"}}