Association between the ApoB/ApoA1 ratio and both the severity and mortality of metabolic dysfunction-associated fatty liver disease

The association between the ApoB/ApoA1 ratio and the severity and prognosis of hepatic steatosis in metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. This study aims to elucidate the association between the ApoB/ApoA1 ratio and the severity of hepatic steatosis in this population, as well as its connections to all-cause and cause-specific mortality. Data for this research were sourced from Beijing, China, and incorporated from the Third National Health and Nutrition Examination Survey (NHANES III) and the National Death Index (NDI) in the United States. Multivariate logistic regression analysis was employed to examine the relationship between the ApoB/ApoA1 ratio and MAFLD, as well as its severity. Additionally, multivariable Cox regression and restricted cubic spline (RCS) regression models were utilized to evaluate the association between the ApoB/ApoA1 ratio and long-term all-cause and cause-specific mortality among MAFLD patients, including subgroup analyses. After adjusted for confounders, a significant correlation was identified between the ApoB/ApoA1 ratio and both the presence of MAFLD and its severity (all P < 0.05). In mortality analyses, the multivariate Cox regression, also adjusted for confounders, indicated that the ApoB/ApoA1 ratio was significantly linked to overall mortality (HR = 1.52, 95%CI: 1.17–1.98, P = 0.002), cardiovascular-related mortality (HR = 1.76, 95%CI: 1.12–2.77, P = 0.014), and diabetes-related mortality (HR = 2.20, 95%CI: 1.21–4.01, P = 0.010) among MAFLD patients. The RCS curves displayed a linear relationship between the ApoB/ApoA1 ratio and both all-cause and cause-specific mortality (all P for non-linear > 0.05) within the MAFLD cohort. Furthermore, insulin resistance-related indicators mediated the association between the ApoB/ApoA1 ratio and all-cause mortality. The findings of this study suggest that the ApoB/ApoA1 ratio is a significant predictor for assessing the severity of MAFLD and hepatic steatosis. Furthermore, insulin resistance-related indicators mediated the association between the ApoB/ApoA1 ratio and all-cause mortality. This study investigates the association between the ApoB/ApoA1 ratio and MAFLD along with its hepatic steatosis severity in both Chinese and American populations. Using data from the NHANES, the analysis further evaluated relationships between the ApoB/ApoA1 ratio and both all-cause and cause-specific mortality among MAFLD patients. • The ApoB/ApoA1 ratio represents an important predictive biomarker for assessing MAFLD severity and hepatic steatosis progression. • The ApoB/ApoA1 ratio also functions as a valuable prognostic indicator, with insulin resistance-related parameters mediating its association with all-cause mortality.