ORIGINAL RESEARCH article
Front. Med.
Sec. Hepatobiliary Diseases
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1569655
This article is part of the Research TopicHot Topics in Diabetes and Steatotic Liver DiseaseView all 15 articles
Unanticipated Discovery: Basal Metabolic Rate as an Independent Risk Factor for Metabolic Dysfunction-Associated Steatotic Liver Disease in a 5-Year Longitudinal Cohort Study of Nonobese Individuals in China
Provisionally accepted
- 1Department of Endocrinology, The First People's Hospital of Changde City, Changde, China
- 2Department of Gastroenterology, The First People's Hospital of Changde City, Changde, China
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Objective: The role of basal metabolic rate (BMR) in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains controversial, with previous studies yielding inconsistent results. The precise relationship remains poorly understood, particularly in non-obese individuals. This study aimed to investigate the longitudinal association between BMR and incident MASLD in a large, non-obese Chinese cohort. Methods: This longitudinal cohort study included 16,173 nonobese participants free of MASLD at baseline. They were prospectively followed up for five years, with the outcome event being the development of MASLD. Participants were divided into quartiles based on their basal metabolic rate (BMR). The association between BMR and incident MASLD was examined using both Cox regression models and restricted cubic spline analysis (RCS). Results: During the 5-year follow-up period, 2,322 nonobese participants developed MASLD. Multivariate Cox regression analysis revealed that after fully adjusting for relevant confounding factors, the BMR was positively associated with incident MASLD, and the risk of MASLD gradually increased with increasing BMR (HR: 1.3, 95% CI: 1.3, 1.4; P for trend < 0.0001). Using RCS regression, we found a positive linear correlation between the BMR and the risk of incident MASLD. Stratified analysis revealed an association between the BMR and increased incidence of MASLD in all the subgroups. Additionally, significant interactions were found between BMR and sex, systolic blood pressure (SBP), uric acid (UA), creatinine (CR), and triglycerides (TGs) (P for interaction < 0.05). Mediation analysis indicated that insulin resistance mediated 5.16% of the effect of the BMR on incident MASLD. Conclusions: In this non-obese Chinese cohort, an elevated BMR was identified as an independent risk factor for incident MASLD. This suggests that BMR could be a valuable early biomarker for MASLD risk stratification, even in individuals without obesity.
Keywords: basal metabolic rate, Metabolic dysfunction-associated fatty liver disease, nonalcoholic fatty liver disease, Insulin Resistance, Mediation analysis
Received: 01 Feb 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Luo, Gong, Guo, Cheng and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xueyan Wu, Department of Gastroenterology, The First People's Hospital of Changde City, Changde, China
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