{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T02:45:49Z","timestamp":1785725149485,"version":"3.56.0"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to systemic cardiometabolic dysfunction. Resting heart rate (RHR), a marker of autonomic and metabolic stress, has been associated with metabolic syndrome and cardiovascular disease, though its relationship with MASLD remains incompletely characterized. We evaluated the association between RHR and liver-related outcomes in a nationally representative U.S. cohort. Materials and Methods: We analyzed adults aged 20\u201379 years from NHANES 2017\u20132020 with valid vibration-controlled transient elastography (VCTE) measurements. Participants with significant alcohol use, viral hepatitis, pregnancy, use of heart rate-modifying medications, or missing key data were excluded. Liver outcomes included elevated alanine aminotransferase (ALT), advanced steatosis (CAP \u2265 290 dB\/m), FIB-4 fibrosis category, and VCTE-defined fibrosis. Multivariable regression models adjusted for demographic and metabolic covariates were used to evaluate associations between RHR and liver-related outcomes. Results: A total of 3532 adults were included. Each 1 beat-per-minute increase in RHR was independently associated with elevated ALT (OR 1.025, 95% CI 1.002\u20131.050, p = 0.043) and advanced steatosis (OR 1.036, 95% CI 1.001\u20131.073, p = 0.048). No significant association was observed between RHR and higher FIB-4 category (OR 1.025, 95% CI 0.992\u20131.060, p = 0.169) or VCTE-defined fibrosis (OR 0.990, 95% CI 0.961\u20131.021, p = 0.481). Associations with ALT and steatosis were attenuated after adjustment for glycemic and lipid parameters. Conclusions: Higher RHR was associated with steatosis-related and metabolic liver outcomes, but not fibrosis, in a nationally representative cohort. These findings suggest that RHR may reflect underlying autonomic and metabolic dysfunction relevant to early MASLD pathogenesis rather than advanced fibrotic disease.<\/jats:p>","DOI":"10.3390\/medicina62081480","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T01:43:27Z","timestamp":1785721407000},"page":"1480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Resting Heart Rate as a Physiologic Marker of Steatosis in MASLD: NHANES 2017\u20132020 Analysis"],"prefix":"10.3390","volume":"62","author":[{"given":"Ethan","family":"Shamsian","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Ralph","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahinaz","family":"Mohsen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6934-704X","authenticated-orcid":false,"given":"Anika","family":"Makol","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-2482","authenticated-orcid":false,"given":"Rohan","family":"Karkra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bebawy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Hassaan Arif","family":"Maan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fariha","family":"Ilyas","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5428-9848","authenticated-orcid":false,"given":"Ahmed","family":"Al-Khazraji","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7841-3329","authenticated-orcid":false,"given":"Paul","family":"Gaglio","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1016\/j.cgh.2024.03.006","article-title":"The Global Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Among Patients with Type 2 Diabetes","volume":"22","author":"Younossi","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/gutjnl-2023-330595","article-title":"MASLD: A systemic metabolic disorder with cardiovascular and malignant complications","volume":"73","author":"Targher","year":"2024","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1210\/jc.2009-2801","article-title":"HIncreased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities","volume":"95","author":"Licht","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1210\/jc.2012-3104","article-title":"Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome","volume":"98","author":"Licht","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Yang, Z., Zhang, W., Zhu, L., Lin, N., Niu, Y., Li, X., Lu, S., Zhang, H., Wang, X., and Wen, J. (2017). Resting heart rate and impaired glucose regulation in middle-aged and elderly Chinese people: A cross-sectional analysis. BMC Cardiovasc. Disord., 17.","DOI":"10.1186\/s12872-017-0675-2"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s00592-013-0503-9","article-title":"Resting heart rate predicts metabolic syndrome in apparently healthy non-obese Japanese men","volume":"51","author":"Oda","year":"2014","journal-title":"Acta Diabetol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.acvd.2010.03.004","article-title":"Association between resting heart rate and arterial stiffness in Korean adults","volume":"103","author":"Park","year":"2010","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1136\/heartjnl-2014-305685","article-title":"Metabolic syndrome is associated with and predicted by resting heart rate: A cross-sectional and longitudinal study","volume":"101","author":"Jiang","year":"2015","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jacc.2021.11.007","article-title":"Risk of Heart Failure in Patients with Nonalcoholic Fatty Liver Disease","volume":"79","author":"Mantovani","year":"2022","journal-title":"JACC"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S2468-1253(21)00308-3","article-title":"Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: An updated systematic review and meta-analysis","volume":"6","author":"Mantovani","year":"2021","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1136\/gutjnl-2021-325724","article-title":"Non-alcoholic fatty liver disease and incident major adverse cardiovascular events: Results from a nationwide histology cohort","volume":"71","author":"Simon","year":"2022","journal-title":"Gut"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2839","DOI":"10.1002\/hep.32072","article-title":"Nonalcoholic Fatty Liver Disease and Cardiac Remodeling Risk: Pathophysiological Mechanisms and Clinical Implications","volume":"74","author":"Zhou","year":"2021","journal-title":"Hepatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1161\/CIRCRESAHA.121.319059","article-title":"Nonalcoholic Fatty Liver Disease: An Emerging Driver of Cardiac Arrhythmia","volume":"128","author":"Chen","year":"2021","journal-title":"Circ. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e19529","DOI":"10.1097\/MD.0000000000019529","article-title":"Association of resting heart rate with nonalcoholic fatty liver disease in postmenopausal women","volume":"99","author":"Kim","year":"2020","journal-title":"Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/liv.15556","article-title":"Fatty liver disease, heart rate and cardiac remodelling: Evidence from the UK Biobank","volume":"43","author":"Jamialahmadi","year":"2023","journal-title":"Liver Int."},{"key":"ref_16","doi-asserted-by":"crossref","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":"ref_17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4239\/wjd.v5.i1.17","article-title":"Cardiac autonomic neuropathy in patients with diabetes mellitus","volume":"5","author":"Dimitropoulos","year":"2014","journal-title":"World J. Diabetes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103845","DOI":"10.4330\/wjc.v17.i2.103845","article-title":"Heart failure with preserved ejection fraction and metabolic dysfunction-associated steatotic liver disease: Twin challenges, one metabolic solution","volume":"17","author":"Lian","year":"2025","journal-title":"World J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1053\/j.gastro.2026.01.047","article-title":"Clinical Care Pathway for the Risk Stratification and Management of Patients With Metabolic Dysfunction\u2013Associated Steatotic Liver Disease","volume":"171","author":"Kanwal","year":"2026","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"He, W., An, X., Li, L., Shao, X., Li, Q., Yao, Q., and Zhang, J.-A. (2017). Relationship between Hypothyroidism and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis. Front. Endocrinol., 8.","DOI":"10.3389\/fendo.2017.00335"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T02:17:28Z","timestamp":1785723448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081480"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081480","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}