Lipids & metabolic liver disease
Frailty may confound the association between MASLD and cardiovascular mortality in people with cardiometabolic risk factors
Authors' conclusion
Frailty may confound the MASLD-CVD mortality relationship in people with cardiometabolic risk factors. The association between MASLD and CVD mortality is detected only when frailty is adjusted for.
Study context
- Population
- US NHANES III adults with ≥ 1 cardiometabolic risk factor (obesity, hypertension, DM or dyslipidemia); frailty by 49-item frailty index, in quartiles
- Participants
- 10,413 adults
- Exposure
- MASLD vs no MASLD, with and without frailty adjustment
- Outcome
- CVD mortality
- Follow-up
- Mean 23.36 years
Methodological detailsNHANES III, multivariable Cox proportional hazards models, interaction and mediation analyses
- NHANES III
- Multivariable Cox proportional hazards models
- Interaction and mediation analyses
Main finding
As reported in the abstract
MASLD vs No MASLDHazard ratio (95% CI)
Without frailty adjustment
0.92(0.78–1.10)
After frailty adjustment
1.19(1.07–1.32)
- Cardiovascular disease (CVD) deaths
- 1,375 (13.20%)
Observational data: associations, not effects.
Further findings
MASLD and CVD mortality, stratified by frailty index (FI) quartiles
- FI Q3: HR
- 1.35 (1.03-1.77) (95% CI)
- FI Q4: HR
- 1.70 (1.07-2.69) (95% CI)
- Significant associations only in the higher frailty quartiles
Population attributable fraction of MASLD for CVD mortality, after frailty adjustment
- Population attributable fraction
- 10.1-12.5%
Interaction and mediation by frailty
- No evidence of interaction between MASLD and frailty
- No indirect effect of MASLD on CVD mortality through frailty
Original publication
Frailty may confound the association between MASLD and cardiovascular mortality in people with cardiometabolic risk factors. Cardiovasc Diabetol. Published 11 July 2026. doi:10.
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