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

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.