Association between weight fluctuation and the risk of metabolic dysfunction-associated steatotic liver disease

Table 1 Baseline demographic characteristics, n (%)

Baseline characteristics	Overall population (n = 8191)	Patterns of weight change1				P value
		Stabilizing non-obesity (n = 4565)	Obesity to non-obesity (n = 491)	Non-obesity to obesity (n = 1348)	Stabilizing obesity (n = 1787)
Age (year)	55.49 (0.22)	55.49 (0.29)	59.40 (0.75)	52.75 (0.42)	56.53 (0.31)	< 0.0001
Gender						0.0003
Male	4036 (48.72)	2346 (48.60)	282 (57.10)	541 (43.28)	867 (50.97)
Women	4155 (51.28)	2219 (51.40)	209 (42.90)	807 (56.72)	920 (49.03)
Race						< 0.0001
Non-Hispanic White	3777 (73.05)	2184 (74.81)	219 (72.59)	540 (66.61)	834 (73.30)
Non-Hispanic Black	1568 (9.19)	720 (7.22)	99 (9.87)	326 (12.80)	423 (11.58)
Mexican	1134 (6.49)	529 (5.10)	94 (8.87)	233 (9.53)	278 (7.30)
Other Hispanics and mestizos	1712 (11.27)	1132 (12.87)	79 (8.66)	249 (11.06)	252 (7.83)
Marital status						0.0197
Married	4840 (64.84)	2783 (66.83)	277 (63.84)	759 (61.31)	1021 (62.45)
Else	3348 (35.16)	1782 (33.17)	214 (36.16)	588 (38.69)	764 (37.55)
Mean body mass index (kg/m2)
25 years old	24.16 (0.07)	22.37 (0.06)	26.24 (0.30)	24.07 (0.14)	28.432 (0.16)	< 0.0001
10 years before baseline	27.53 (0.11)	24.13 (0.06)	32.77 (0.13)	26.97 (0.08)	35.64 (0.18)	< 0.0001
Baseline	29.16 (0.12)	25.02 (0.07)	27.56 (0.13)	33.53 (0.12)	37.23 (0.19)	< 0.0001
Net weight change (kg)	4.56 (0.20)	2.50 (0.13)	-14.84 (0.49)	18.34 (0.41)	4.61 (0.47)	< 0.0001
Level of education3						< 0.0001
High school dropout or below	2110 (16.56)	1112 (15.45)	153 (20.13)	370 (18.82)	475 (16.95)
Graduate from high school	1868 (22.34)	1030 (21.77)	118 (22.59)	313 (24.08)	407 (22.50)
Drop out of college	2203 (29.43)	1107 (25.95)	147 (35.14)	413 (33.00)	536 (34.57)
University graduate or above	2003 (31.66)	1311 (36.83)	73 (22.14)	251 (24.09)	368 (25.98)
Household income poverty ratio3						< 0.0001
0-1.0	1434 (11.48)	742 (10.41)	104 (15.60)	265 (13.44)	323 (11.85)
1.1-3.0	3119 (33.95)	1659 (31.50)	220 (42.09)	518 (36.14)	722 (36.82)
> 3.0	2982 (54.57)	1797 (58.09)	123 (42.32)	444 (50.42)	618 (51.33)
Smoking status3						< 0.0001
Never smoked	4243 (51.75)	2356 (51.87)	222 (45.38)	717 (51.10)	948 (53.48)
Cessation	2373 (29.91)	1264 (28.02)	153 (33.58)	379 (29.91)	577 (34.00)
Smoking	1569 (18.34)	941 (20.11)	115 (21.05)	251 (18.99)	262 (12.52)
Drinking status3						0.0037
Never	1068 (10.63)	571 (9.76)	73 (14.25)	179 (10.96)	245 (11.73)
Cessation	1134 (12.95)	567 (11.44)	62 (13.69)	189 (13.61)	316 (16.18)
Drinking	5416 (76.43)	3077 (78.80)	325 (72.06)	884 (75.44)	1130 (72.10)
Sports						< 0.0001
Low intensity	5424 (62.68)	2921 (59.41)	337 (65.11)	907 (63.90)	1259 (69.78)
Medium intensity	1119 (15.71)	680 (17.12)	63 (16.31)	169 (15.46)	207 (12.01)
High intensity	1648 (21.62)	964 (23.47)	91 (18.57)	272 (20.64)	321 (18.21)
History of the tumor						0.0001
None	7222 (87.32)	4018 (87.01)	408 (82.00)	1236 (91.74)	1560 (86.15)
Have	962 (12.68)	543 (12.99)	81 (18.00)	112 (8.26)	226 (13.85)
History of diabetes						< 0.0001
None	6667 (87.64)	4071 (94.05)	313 (71.79)	1094 (87.10)	1189 (74.57)
Have	1276 (12.36)	401 (5.95)	158 (28.21)	205 (12.90)	512 (25.43)
History of cardiovascular disease						< 0.0001
None	4195 (55.18)	2771 (65.39)	189 (40.24)	638 (49.15)	597 (36.40)
Have	3996 (44.82)	1794 (34.61)	302 (59.76)	710 (50.85)	1190 (63.60)

¹Weight fluctuation patterns in mid-to-late adulthood (10 years before baseline to baseline).

²It provides a statistical breakdown based on the patterns of weight fluctuation from 10 years before baseline to baseline itself (as indicated in the annotations of Table 1). The weight fluctuation patterns pertained to two time points, with the endpoint being body mass index (BMI) at baseline. "Stable obesity" does not require that all three time points have a BMI greater than 30, and there is no restriction on the BMI at the age of 25, so it is possible for this value to be < 30.

³During baseline data analysis, covariate missingness was identified within the dataset. These missing values were not generalized into separate categories for subsequent weighting calculations.

It provides the baseline characteristics of the analyzed population, summarizing and counting the four patterns of weight change. We also analyzed the number and percentage of people with the four patterns of weight fluctuation under different variable conditions. This was only a portion of the baseline data analyzed in the statistical analysis (mid-to-late adulthood).

Table 2 Effect of weight fluctuation and physical activity intensity on the risk of metabolic dysfunction-associated steatotic liver disease prevalence

Weight fluctuation assessment	Overall population		Low-intensity physical activity		Medium-intensity physical activity		High-intensity physical activity
	MASLD	OR (95%CI)	MASLD	OR (95%CI)	MASLD	OR (95%CI)	MASLD	OR (95%CI)
Weight fluctuation patterns
Mid-to-late adulthood
Stabilizing non-obesity	924	1	614	1	121	1.00 (0.71-1.40)	189	0.85 (0.64-1.13)
Obesity to non-obesity	159	1.21 (0.85-1.72)	113	1.21 (0.78-1.86)	19	0.90 (0.37-2.18)	27	1.27 (0.60-2.66)
Non-obesity to obesity	836	8.97 (7.40-10.88)1	571	9.46 (7.35-12.19)3	98	9.39 (5.85-15.07)3	167	6.24 (4.37-8.91)3
Stabilizing obesity	1264	11.87 (9.65-14.60)1	896	13.64 (10.59-17.57)3	145	11.65 (7.07-19.20)3	223	6.42 (4.24-9.72)3
Early adulthood
Stabilizing non-obesity	1051	1	702	1	140	0.96 (0.69-1.35)	209	0.84 (0.65-1.09)
Obesity to non-obesity	32	0.56 (0.26-1.22)	25	0.33 (0.15-0.71)	0	0.00 (0.00-0.00)	7	0.99 (0.33-2.94)
Non-obesity to obesity	1685	9.58 (8.08-11.37)1	1185	10.29 (8.43-12.55)	193	10.03 (6.44-15.61)	307	6.11 (4.48-8.32)
Stabilizing obesity	415	12.51 (9.33-16.78)1	282	16.14 (11.00-23.70)	50	10.05 (5.75-17.56)	83	5.74 (3.27-10.11)
Net weight change
Mid-to-late adulthood
≤ -2.5 kg	617	0.67 (0.51-0.90)	432	0.65 (0.46-0.93)	70	0.58 (0.33-1.02)	115	0.52 (0.32-0.85)
-2.5 to 2.5 kg	435	12	305	14	56	0.85 (0.45-1.60)	74	0.74 (0.43-1.26)
2.5-10 kg	846	1.37 (1.09-1.73)	570	1.39 (1.01-1.90)	109	1.11 (0.68-1.80)	167	0.98 (0.65-1.48)
10-20 kg	728	2.03 (1.57-2.62)2	485	1.92 (1.32-2.78)	96	2.47 (1.47-4.15)	147	1.20 (0.72-2.01)
> 20 kg	557	4.78 (3.37-6.76)2	402	4.93 (3.17-7.65)	52	3.10 (1.38-6.96)4	103	3.69 (2.10-6.46)4
Early adulthood
≤ -2.5 kg	163	0.97 (0.54-1.74)	119	1.02 (0.50-2.10)	16	0.62 (0.18-2.13)	28	0.72 (0.32-1.62)
-2.5 to 2.5 kg	111	1	73	1	12	0.71 (0.30-1.69)	26	0.86 (0.42-1.76)
2.5-10 kg	405	1.36 (0.92-2.02)	265	1.48 (0.87-2.51)	53	1.05 (0.53-2.09)	87	0.92 (0.50-1.70)
10-20 kg	885	2.49 (1.71-3.61)	571	2.27 (1.37-3.77)	119	2.56 (1.52-4.32)	195	2.04 (1.25-3.36)
> 20 kg	1619	5.73 (3.66-8.98)	1166	5.89 (3.41-10.17)	183	5.33 (2.88-9.89)	270	3.53 (1.96-6.34)

¹Odds ratio (metabolic dysfunction-associated steatotic liver disease prevalence risk) for two patterns of weight change, non-obesity to obesity or stable obesity, 10 years before baseline and at 25 years old, compared with stabilizing non-obesity.

²Odds ratio (metabolic dysfunction-associated steatotic liver disease prevalence risk) for two patterns of net weight change, weight gain of 10-20 kg and weight gain greater than 20 kg, 10 years before baseline to baseline, compared with weight fluctuations of less than 2.5 kg.

³Odds ratio (metabolic dysfunction-associated steatotic liver disease prevalence risk) of different exercise intensities in two weight change patterns, non-obesity to obesity or stable obesity, 10 years before baseline, compared with stabilizing non-obesity.

⁴10 years before baseline to baseline, the odds ratio (metabolic dysfunction-associated steatotic liver disease prevalence risk) was higher for high-intensity exercise than for moderate-intensity exercise, in the group that net weight change > 20 kg, compared with net weight change within 2.5 kg.

Table 2 presents the effects and correlations between the three exercise intensity levels and the prevalence of metabolic dysfunction-associated steatotic liver disease across distinct population groups. The analysis stratified participants into four distinct body weight fluctuation patterns and five net weight change categories, with temporal differentiation between mid-to-late adulthood and early adulthood observations. MASLD: Metabolic dysfunction-associated steatotic liver disease; OR: Odds ratio.

Table 3 Effect of weight fluctuation patterns and physical activity intensity on the risk of metabolic dysfunction-associated steatotic liver disease prevalence

Weight fluctuation patterns	Overall population	Low-intensity sports	Medium-intensity sports	High-intensity sports
	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)
No medical history
Stabilizing non-obesity	1	1	0.72 (0.42-1.21)	0.57 (0.36-0.90)
Obesity to non-obesity	0.76 (0.33-1.77)	1.10 (0.40-3.06)	0.26 (0.04-1.68)	0.10 (0.01-0.74)
Non-obesity to obesity	9.90 (6.79-14.45)	8.20 (5.23-12.84)	9.13 (4.44-18.78)	7.31 (3.84-13.92)
Stabilizing obesity	11.64 (7.63-17.76)	13.85 (8.24-23.29)	9.77 (4.63-20.65)	4.05 (2.08-7.90)
Age ≥ 45 years
Stabilizing non-obesity	1	1	0.96 (0.65-1.40)	0.86 (0.63-1.19)
Obesity to non-obesity	1.39 (0.94-2.07)	1.31 (0.82-2.09)	0.99 (0.36-2.70)	1.78 (0.78-4.04)
Non-obesity to obesity	8.39 (6.47-10.88)	9.20 (6.70-12.63)	9.21 (5.14-16.51)	4.47 (2.81-7.09)
Stabilizing obesity	11.96 (9.32-15.34)	12.68 (9.56-16.83)	16.42 (9.03-29.88)	6.37 (3.95-10.27)
Not underweight
Stabilizing non-obesity	1	1	1.00 (0.70-1.42)	0.90 (0.67-1.22)
Obesity to non-obesity	1.23 (0.86-1.77)	1.24 (0.79-1.93)	0.92 (0.37-2.27)	1.36 (0.65-2.83)
Non-obesity to obesity	8.96 (7.35-10.92)	9.55 (7.37-12.38)	9.55 (5.86-15.55)	6.38 (4.40-9.25)
Stabilizing obesity	11.97 (9.71-14.76)	13.99 (10.81-18.11)	11.82 (7.17-19.48)	6.57 (4.34-9.95)

Table 3 presents the comparative epidemiological risk profiles of metabolic dysfunction-associated steatotic liver disease prevalence across the distinct exercise intensity gradients, focusing specifically on the sensitivity analysis-excluded subpopulations. OR: Odds ratio.