Association between biological aging and premature mortality among patients with metabolic dysfunction-associated steatotic liver disease.
BACKGROUND Biological aging is a well-established risk factor for age-related diseases. However, its specific impact on patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. This study aimed to investigate the association between biological aging and premature mortality among patients with MASLD. METHODS Data from 10,933 participants in the National Health and Nutrition Examination Survey (NHANES) were analyzed. Biological aging was quantified using the Gompertz Law-Based Biological Age (GOLD BioAge) metric. Accelerated biological aging was determined by calculating the difference between biological age and chronological age. Logistic regression models were applied to assess the cross-sectional association between biological aging and MASLD. Within the MASLD cohort, Fine‑Gray competing risks model were used to evaluate the longitudinal relationship between biological aging and premature mortality. Additionally, restricted cubic spline (RCS) analysis was performed to assess potential nonlinear associations. RESULTS Among all participants, a significant linear association emerged between GOLD BioAgeDiff and MASLD(OR = 1.11, 95% CI: 1.09-1.13, p < 0.001). Participants with biological age acceleration had significantly higher odds of MASLD compared with those without acceleration (OR = 2.13, 95% CI: 1.82-2.50, p < 0.001). Among the 3849 participants with MASLD, GOLD BioAgeDiff showed a linear association with premature mortality. Compared with the first tertile (T1), the cumulative incidence of premature mortality was significantly higher in T3 (SHR = 4.05, 95% CI:2.32-7.07, p < 0.001). Participants with biological age acceleration had a 139% higher cumulative incidence of premature mortality compared to those without acceleration (HR = 2.39, 95% CI: 1.56-3.66, p < 0.001). CONCLUSION This study demonstrated a significant association of GOLD BioAgeDiff with MASLD. Biological age acceleration increases the cumulative incidence of premature mortality among individuals with MASLD.