ORIGINAL RESEARCH article
Front. Med.
Sec. Hepatobiliary Diseases
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1569992
Association between perceived stress and MAFLD partially mediated by smoking and drinking
Provisionally accepted
- 1Health Management Institute, Second Medical Center, Chinese PLA General Hospital, Beijing, China, Beijing, China
- 2People's Liberation Army General Hospital, Beijing, Beijing Municipality, China
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Background: Although the association between stress and NAFLD has been suggested, the effect of perceived stress on MAFLD has yet to be investigated. In this study, we explore the association between perceived stress and MAFLD. Methods: We performed a cross-sectional study including 36,847 subjects who underwent health check-ups from January 2011 to December 2021. MAFLD was defined as both fatty liver disease and metabolic dysfunction. The level of perceived stress was measured using the Chinese version of the 14-item Perceived Stress Scale (PSS-14). Logistic regression were performed to explore the association between perceived stress and MAFLD , and mediation analysis were used to examine smoking or drinking that may mediate the effects of perceived stress on MAFLD. Results: The prevalence of MAFLD was 37.10% (13,672/36847). After controlling for sex, age, and BMI, the MAFLD incidence in subjects with a high level of perceived stress was significantly greater than that in subjects with a low level of perceived stress (40.4% vs. 34.9%) (P< 0.001). Perceived stress was positively associated with MAFLD (OR 1.076, 95% CI [1.005-1.153], P=0.036). MAFLD subjects with high perceived stress level exhibited higher rates of smoking, drinking and physical inactivity compared with non-MAFLD subjects. The mediation analysis revealed that the association between perceived stress and MAFLD was partially mediated by smoking and drinking, with a synergistic effect observed in individuals engaging in both behaviours. Conclusions:This study provided evidence for the potential association between perceived stress and MAFLD and the mediation analysis suggested the association of perceived stress and MAFLD was partially mediated by smoking and drinking. Public health strategies should target both smoking and drinking especially in high-stress populations, given their compounded risk for MAFLD.
Keywords: metabolic-related fatty liver disease, perceived stress, physical inactivity, Causal mediation analysis, Smoking, Drinking
Received: 02 Feb 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Gong, Jiang, Wang, Zeng, Wang and Lv. 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: Wenping Lv, People's Liberation Army General Hospital, Beijing, 100853, Beijing Municipality, China
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