ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Metabolism
Association between Metabolic Syndrome, Fatty Liver Disease, and Gastrointestinal Tumors: A Population-Based Study with External Validation
Provisionally accepted
- Digestive Disease Center, Department of Hepatopancreatobiliary Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
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Background Metabolic Syndrome (MetS), defined by central obesity and disturbances in glucose and lipid metabolism, has not been extensively validated in large national cohorts concerning its association with fatty liver disease (FL), gastrointestinal tumors (GIT), and prognostic outcomes. Methods A total of 24,434 adults from the 2003–2018 cycles of The National Health and Nutrition Examination Survey (NHANES) were included as the development cohort, with a validation cohort of 365 adults to verify key associations. MetS was diagnosed per NCEP-ATP III criteria across both cohorts. Weighted multivariate regression models assessed associations between MetS and FL/GIT incidence, and Cox proportional hazards models evaluated survival risks. Three hierarchical models were constructed: Model 1 (unadjusted), Model 2 (adjusted for demographic confounders), and Model 3 (further adjusted for laboratory parameters). Results In the development cohort, MetS patients exhibited a higher FL prevalence (16.2% vs. 4.6%) and GIT incidence (1.25% vs. 0.57%). After full adjustment in Model 3, MetS remained a strong independent risk factor for FL (OR=3.889, 95% CI: 3.529–4.307) and GIT (OR=2.456, 95% CI: 1.832–3.292). These associations were corroborated in the validation cohort, with adjusted ORs of 4.760 for FL and 4.395 for GIT. Survival analysis indicated that MetS significantly reduced overall survival in the development cohort, with HRs for all-cause, cancer-specific, and cardiovascular mortality of 2.146, 1.941, and 2.572, respectively. Furthermore, the mortality risk was further elevated in FL patients with MetS (all-cause mortality HR=1.823). In the validation cohort, cardiovascular mortality risk was significant (HR=3.902), while other survival outcomes did not reach statistical significance due to the small sample size. Sensitivity analysis using IDF criteria confirmed the robustness of these findings. Conclusions This study confirms that MetS is strongly associated with FL risk and GIT incidence, supporting early metabolic intervention to interrupt the progression of liver disease and tumors.
Keywords: Fatty liver disease, Gastrointestinal tumors, metabolic syndrome, Population study, survivaloutcomes
Received: 17 Sep 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Zhang, Song, Liu, Yang, Zhang and Jin. 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:
Qian Zhang
Zhenjing Jin
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