# MAFLD increases CKM syndrome severity: a NHANES-based cross-sectional study

## TL;DR

This study shows that MAFLD is linked to more severe CKM syndrome, highlighting the importance of liver health in managing heart and kidney risks.

## Contribution

The study is the first to demonstrate MAFLD as an independent predictor of CKM syndrome severity using NHANES data.

## Key findings

- MAFLD was an independent predictor of advanced CKM stages (OR: 1.2, p=0.04).
- Participants with MAFLD showed higher cardiometabolic risks and greater liver fibrosis.
- Late CKM stages had a higher prevalence of MAFLD compared to earlier stages (57.7% vs 53.2%).

## Abstract

The cardiovascular-kidney-metabolic (CKM) syndrome is a newly proposed clinical concept that emphasizes the interconnected burden of renal and cardiometabolic dysfunction. However, the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) within the CKM staging framework is still unknown. This cross-sectional study utilized data from the U.S. National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020. Participants aged 18–80 were categorized by CKM staging was applied based on the 2023 American Heart Association classification, MAFLD status, and liver fibrosis was assessed by transient elastography and non-invasive scores. Logistic regression was used to identify independent predictors of advanced CKM stages. Of 6167 participants, 5695 (92.3%) met the CKM Framework, with 3137 (55.1%) having MAFLD (CKM-MAFLD). Those with CKM-MAFLD exhibited significantly higher cardiometabolic risks, particularly for cardiovascular events. Late CKM stages showed a higher prevalence of MAFLD (57.7% vs 53.2%, p < 0.001) and greater steatosis and fibrosis. MAFLD was an independent predictor of CKM risk (OR: 1.2, 95% CI: 1.03–1.5, P 0.04), an effect was more profound in those with liver fibrosis (OR: 1.36, p-value 0.004). MAFLD could be a crucial predictor in CKM risk stratification, emphasizing the need for hepatic evaluation in these frameworks. Early identification of MAFLD-related dysfunction can lead to targeted interventions across the liver-heart-kidney continuum.

The online version contains supplementary material available at 10.1007/s10238-025-01997-1.