The Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Peripheral Arterial Disease in the Chinese Population

Figures & data

Figure 1 Study flow chart.

Notes: (A) Flow chart of participants in the cross-sectional analysis. (B) Flow chart of participants in the prospective cohort analysis.

Abbreviations: PAD, peripheral arterial disease; MAFLD, metabolic dysfunction-associated fatty liver disease; CHD, coronary heart disease; AF, atrial fibrillation; LVH, left ventricular hypertrophy; VHD, valvular heart disease; RHD, rheumatic heart disease; HF, heart failure.

Table 1 Baseline Characteristics of Participants in the Cross-Sectional Study

Characteristics	Total	Non-MAFLD	MAFLD	P value
	N = 101,465	N = 49,700	N = 51,765
Demographics
Age (year, mean (SD))	49.8 (10.0)	49.1 (11.0)	50.5 (8.9)	<0.001
Gender, male, n (n%)	66,235 (65.3)	24,813 (49.9)	41,422 (80.0)	<0.001
BMI (kg/m^2, mean (SD))	24.9 (3.4)	22.8 (2.6)	26.9 (2.8)	<0.001
WC (cm, mean (SD))	86.8 (10.7)	80.1 (8.7)	93.1 (8.2)	<0.001
SBP (mmHg, mean (SD))	122.3 (18.1)	117.3 (17.3)	127.2 (17.4)	<0.001
DBP (mmHg, mean (SD))	77.7 (11.6)	74.2 (10.6)	81.1 (11.4)	<0.001
Laboratory examination
FBG (mmol/L, mean (SD))	5.6 (1.4)	5.2 (1.0)	5.9 (1.6)	<0.001
TC (mmol/L, mean (SD))	4.9 (1.0)	4.8 (0.9)	5.0 (1.0)	<0.001
TG (mmol/L, mean (SD))	1.9 (1.8)	1.3 (1.1)	2.4 (2.2)	<0.001
HDL-c (mmol/L, mean (SD))	1.3 (0.4)	1.5 (0.4)	1.2 (0.3)	<0.001
LDL-c (mmol/L, mean (SD))	2.9 (0.9)	2.8 (0.8)	3.1 (0.9)	<0.001
TBIL (μmol/L, mean (SD))	12.6 (5.8)	12.9 (5.9)	12.3 (5.6)	<0.001
ALT (IU/L, mean (SD))	26.1 (24.1)	20.9 (22.1)	31.2 (24.9)	<0.001
AST (IU/L, mean (SD))	21.8 (14.6)	20.5 (14.5)	22.9 (14.7)	<0.001
Creatinine (μmol/L, mean (SD))	68.8 (17.3)	66.5 (18.5)	71.0 (15.6)	<0.001
LEU (×10^9/L, mean (SD))	6.2 (1.8)	6.0 (1.9)	6.4 (1.7)	<0.001
RBC (×10^12/L, mean (SD))	4.8 (0.5)	4.6 (0.5)	4.9 (0.4)	<0.001
HGB (g/L, mean (SD))	144.2 (16.0)	138.8 (16.3)	149.3 (13.8)	<0.001
PLT (×10^9/L, mean (SD))	218.3 (55.6)	216.3 (56.8)	220.2 (54.4)	<0.001
FIB-4 (mean (SD))	1.1 (0.7)	1.2 (0.8)	1.1 (0.6)	<0.001
eGFR (mL/ (min·1.73 m^2), mean (SD))	115.6 (25.4)	117.2 (25.9)	114.1 (24.9)	<0.001
Comorbidities
Type 2 diabetes, n (n%)	11,976 (11.8)	2275 (4.6)	9701 (18.7)	<0.001
Hypertension, n (n%)	22,676 (22.4)	6986 (14.1)	15,690 (30.4)	<0.001
Dyslipidemia, n (n%)	42,282 (41.7)	11,542 (23.2)	30,740 (59.4)	<0.001
Subclinical atherosclerosis
PAD, n (n%)	2516 (2.5)	1100 (2.2)	1416 (2.7)	<0.001

Notes: P values were calculated by Student’s t-test for normally distributed variables and the Wilcoxon rank-sum test for non-normal distributed variables, as well as the chi-square test or Fisher’s exact test for categorical variables.

Abbreviations: MAFLD, metabolic dysfunction-associated fatty liver disease; SD, standard deviation; BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; TC, total cholesterol; TG, triglycerides; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; TBIL, total bilirubin; ALT, alanine aminotransferase; AST, aspartate transaminase; LEU, leukocyte count; RBC, red blood cell; HGB, hemoglobin; PLT, platelet count; FIB-4, fibrosis 4 Score; eGFR, estimated glomerular filtration rate; PAD, peripheral arterial disease.

Table 2 Association Between MAFLD and the Presence of PAD in the Cross-Sectional Analysis

Groups	Odds Ratio (95% Confidence Interval)
	Crude	P value	Model 1	P value	Model 2	P value
Non-MAFLD	1 (reference)	-	1 (reference)	-	1 (reference)	-
MAFLD	1.49 (1.37–1.62)	<0.001	1.29 (1.19–1.41)	<0.001	1.30 (1.19–1.42)	<0.001
Categories by number of metabolic disorders in MAFLD
Non-MAFLD	1 (reference)	-	1 (reference)	-	1 (reference)	-
MAFLD with one MD	1.14 (0.98–1.32)	0.080	1.05 (0.90–1.22)	0.514	1.06 (0.91–1.23)	0.435
MAFLD with two MD	1.49 (1.36–1.63)	<0.001	1.29 (1.18–1.24)	<0.001	1.31 (1.19–1.44)	<0.001
MAFLD with three MD	2.11 (1.84–2.41)	<0.001	1.64 (1.43–1.89)	<0.001	1.65 (1.43–1.90)	<0.001

Notes: Model 1, the adjustment factors included age, sex; Model 2, the adjustment factors included age, sex, red blood cell, leukocyte count, hemoglobin, platelet count and eGFR. P values were calculated based on generalized linear mixed model.

Table 3 The Association Between Baseline MAFLD and the Incidence of PAD in the Prospective Cohort Analysis

Groups	Incidence Rate	Hazards Ratio (95% Confidence Interval)
	Cases (%)	Crude	P value	Model 1	P value	Model 2	P value
Non-MAFLD	47 (1.8)	1 (reference)	-	1 (reference)	-	1 (reference)	-
MAFLD	144 (3.3)	1.85 (1.33–2.57)	<0.001	1.71 (1.20–2.43)	0.003	1.67 (1.17–2.38)	0.005
Categories by number of metabolic disorders in MAFLD
Non-MAFLD	47 (1.8)	1 (reference)	-	1 (reference)	-	1 (reference)	-
MAFLD with one MD	17 (2.6)	1.44 (0.82–2.50)	0.200	1.34 (0.76–2.37)	0.310	1.31 (0.74–2.31)	0.350
MAFLD with two MD	98 (3.2)	1.80 (1.27–2.56)	0.001	1.69 (1.17–2.44)	0.005	1.64 (1.13–2.38)	0.009
MAFLD with three MD	29 (4.5)	2.46 (1.55–3.92)	<0.001	2.23 (1.37–3.63)	0.001	2.27 (1.39–3.71)	0.001

Notes: Model 1, the adjustment factors included age, sex; Model 2, the adjustment factors included age, sex, red blood cell, leukocyte count, hemoglobin, platelet count and eGFR. P values were calculated based on random-effects Cox proportional hazards model.

Figure 2 Risks of the presence PAD in association with MAFLD in subgroups.

Notes: The model was adjusted for age, sex, red blood cell, leukocyte count, hemoglobin, platelet count and eGFR.

Abbreviations: BMI, body mass index; OR, odds ratio; CI, confidence interval.

Table 4 Sensitivity Test I for PAD in Cross-Section Study After Further Adjusting FIB-4

Group	OR (95% CI)	P value
Non-MAFLD	1 (reference)	-
MAFLD	1.31 (1.20,1.43)	<0.001
Categories by number of metabolic disorders in MAFLD
Non-MAFLD	1 (reference)	-
MAFLD with one MD	1.07 (0.92,1.24)	0.386
MAFLD with two MD	1.32 (1.20,1.45)	<0.001
MAFLD with three MD	1.66 (1.44,1.91)	<0.001

Notes: The adjustment factors included age, sex, red blood cell, leukocyte count, hemoglobin, platelet count, eGFR and FIB-4. P values were calculated based on generalized linear mixed model.

Abbreviations: OR, odds ratio; CI, confidence interval.