Nonlinear Associations of Estimated Pulse Wave Velocity With Hepatic Steatosis and Liver Stiffness in Community-Based People

Abstract

Background Metabolic dysfunction–associated fatty liver disease (MAFLD) and its progressive complication, liver fibrosis, have emerged as global public health burdens. Noninvasive tools for integrated assessment of MAFLD and early fibrogenesis remain limited. This study investigated the association between estimated pulse wave velocity (ePWV) and hepatic steatosis/liver fibrosis and assessed ePWV’s utility in evaluating these conditions. Methods This cross-sectional study included participants from Shanghai community health centers (March–November 2021) as part of a nationwide MAFLD screening project, “Screening of Metabolic Associated Fatty Liver Disease.” Demographic data, medical history, and laboratory/imaging results were collected. Multiple logistic regression and restricted cubic spline (RCS) curves identified associations between ePWV and MAFLD/liver fibrosis. Results A total of 1,116 participants from four community health service centers in Shanghai were enrolled. Among them, 613 had no MAFLD, 232 had light, 202 had moderate and 69 had severe MAFLD, while 886 had no liver fibrosis, 172 had light, 52 had moderate, and six had severe liver fibrosis. Participants with MAFLD or liver fibrosis exhibited higher ePWV values and demonstrated increasing trends across disease severity categories. RCS analyses revealed nonlinear associations between ePWV and both MAFLD and liver fibrosis. When ePWV exceeded 13.26 m/s, the odds ratios (ORs) for MAFLD and liver fibrosis were consistently greater than 1. Conclusions ePWV showed nonlinear associations with MAFLD and liver fibrosis. Values above 13.26 m/s were associated with higher odds of both conditions, suggesting that ePWV may serve as a practical vascular marker of hepatic metabolic dysfunction.