Association of Life’s Essential 8 and Life’s Simple 7 with metabolic-associated fatty liver disease in the United States

Table 1 Weighted characteristics of the United States adult population based on NHANES 2017-2018, percentage (%)/mean ± SD/median (25^th-75^th percentiles)

Variables	LE8
	Total	Low	Moderate	High	P value
N	2234	365	1411	458
Weighted N	126883299.26	17279315.83	77128139.71	32475843.72
Gender
Male	47.13	52.50	49.46	38.71	0.0182
Female	52.87	47.50	50.54	61.29
Age	46.532 ± 16.63	53.419 ± 15.20	48.173 ± 16.49	38.972 ± 14.93	< 0.0001
Age group (yr)
< 40	32.00	27.78	31.99	34.28	0.6517
40-64	43.96	46.96	44.37	41.37
≥ 65	24.05	25.27	23.64	24.35
Poverty-to-income ratio	3.22 ± 1.62	2.71 ± 1.63	3.20 ± 1.60	3.55 ± 1.58	0.0005
Education
Less than high school	1.83	1.64	2.14	1.22	0.0010
Completed high school	5.58	11.11	5.32	3.24
Beyond high school	92.59	87.25	92.54	95.54
Marital
Single	62.86	63.24	64.58	58.55	0.0844
Married	37.14	36.76	35.42	41.45
Race
Mexican Americans	8.31	9.84	8.87	6.16	0.1569
Non-Hispanic Blacks	6.36	4.97	6.22	7.42
Non-Hispanic Whites	64.80	63.38	64.62	66.00
Other Hispanics	10.12	12.74	10.60	7.59
Other races	10.41	9.07	9.69	12.83
Smoke
Never	61.58	28.14	58.75	86.07	< 0.0001
Former	23.39	35.72	25.27	12.38
Current	15.03	36.14	15.98	1.55
Alcohol
No	79.03	77.50	80.09	77.33	0.6295
Yes	20.97	22.50	19.91	22.67
Diabetes
No	88.79	63.90	90.09	98.93	< 0.0001
Yes	11.21	36.10	9.91	1.07
Sleep disorder
No	86.99	75.95	87.18	92.42	0.0006
Yes	13.01	24.05	12.82	7.58
Depression
No	92.58	86.01	92.70	95.78	0.0134
Yes	7.42	13.99	7.30	4.22
Comorbid
No	74.14	50.60	73.28	88.70	< 0.0001
Yes	25.86	49.40	26.72	11.30
BMI	29.55 ± 6.91	36.19 ± 7.34	30.01 ± 6.23	24.95 ± 4.51	< 0.0001
Cap	261.68 ± 61.39	314.67 ± 54.83	267.92 ± 55.37	218.67 ± 49.18	< 0.0001
GGT (IU/L)	20.00 (13.00, 31.00)	27.00 (19.00, 44.00)	21.00 (14.00, 34.00)	15.00 (12.00, 21.00)	< 0.0001
CRP (mg/L)	1.70 (0.81, 3.86)	3.70 (1.69, 7.33)	1.90 (0.94, 3.85)	0.970 (0.56, 1.93)	< 0.0001

LE8: Life’s Essential 8; BMI: Body mass index; GGT: Gamma-glutamyl transferase; CRP: C-reactive protein.

Table 2 Association of Life’s Essential 8 and Life’s Simple 7 with metabolic-associated fatty liver disease (weighted)¹

		Model 0	P value	Model 1	P value	Model 2	P value	Model 3	P value
		OR (95%CI)		OR (95%CI)		OR (95%CI)		OR (95%CI)
LE8 (per 10)	Continuous	0.51 (0.46-0.56)	< 0.001	0.53 (0.48-0.58)	< 0.001	0.5 (0.43-0.59)	< 0.001	0.51 (0.41-0.64)	0.006
LE8 group
	Low	Reference		Reference		Reference		Reference
	Moderate	0.28 (0.19-0.42)	< 0.001	0.30 (0.20-0.45)	< 0.001	0.27 (0.13-0.59)	0.018	0.29 (0.13-0.65)	0.022
	High	0.05 (0.03-0.07)	< 0.001	0.06 (0.04-0.09)	< 0.001	0.05 (0.02-0.14)	0.006	0.06 (0.02-0.15)	0.007
	P for trend		< 0.001		< 0.001		< 0.001		0.001
LS7	Continuous	0.62 (0.57-0.68)	< 0.001	0.63 (0.58-0.68)	< 0.001	0.61 (0.53-0.70)	0.001	0.62 (0.50-0.76)	0.01
LS7 group
	Inadequate	Reference		Reference		Reference		Reference
	Average	0.31 (0.22-0.44)	< 0.001	0.32 (0.22-0.45)	< 0.001	0.29 (0.14-0.60)	0.018	0.32 (0.14- 0.74)	0.028
	Optimal	0.04 (0.02-0.09)	< 0.001	0.05 (0.03-0.10)	< 0.001	0.05 (0.01, 0.18)	0.011	0.05 (0.01- 0.22)	0.013
	P for trend		< 0.001		< 0.001		0.003		0.004

¹Model 0 Unadjusted. Model 1 Adjusted for age and sex.

Model 2 Further adjusted for ethnicity, education, marital status, poverty-income ratio, and alcohol status. Model 3 Further adjusted for comorbid conditions (diabetes, kidney failure, kidney stones, heart failure, stroke, hepatopathy, rheumatoid arthritis, and cancer).

LE8: Life’s Essential 8; LS7: Life’s Simple 7.

Table 3 Association of individual Life’s Essential 8 metric with metabolic-associated fatty liver disease¹

CVH component (per 10)	Crude model			Adjusted model
	OR	95%CI	P value	OR	95%CI	P value
LE8 health behaviors	0.84	0.79-0.90	< 0.001	0.85	0.74-0.99	0.042
LE8 health factors	0.5	0.46-0.55	< 0.001	0.5	0.42-0.60	0.004
DASH score	0.95	0.91-0.99	0.018	0.95	0.87-1.04	0.128
PA score	0.92	0.89-0.94	< 0.001	0.92	0.88-0.97	0.023
Smoking score	0.99	0.97-1.01	0.15	0.99	0.93-1.06	0.636
Sleeping score	0.98	0.93-1.04	0.471	0.98	0.88-1.11	0.623
BMI score	0.7	0.66-0.74	< 0.001	0.69	0.61-0.77	0.006
HDL score	0.86	0.83-0.89	< 0.001	0.88	0.81-0.96	0.026
Glu score	0.75	0.71-0.80	< 0.001	0.79	0.68-0.91	0.019
BP score	0.83	0.79-0.88	< 0.001	0.86	0.77-0.97	0.034

¹Adjusted for age, sex, ethnicity, education, marital status, poverty-to-income ratio, alcohol status, diabetes, kidney failure, kidney stones, heart failure, stroke, hepatopathy, rheumatoid arthritis, and cancer.

CVH: Cardiovascular health; OR: Odds ratio; LE8: Life’s Essential 8; DASH: Dietary Approaches to Stop Hypertension; BMI: Body mass index; HDL: High-density lipoprotein; BP: Blood pressure; Glu: Glucose.