Thyroid-stimulating hormone–body mass index profile and mortality in metabolic dysfunction-associated steatotic liver disease
- 1Department of Interventional Oncology, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- 2Department of VIP Region, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- 3Department of Pathology, State Key Laboratory of Liver Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
Abstract
Background and aims: Thyroid-stimulating hormone (TSH) and body mass index (BMI) are potential prognostic factors in metabolic dysfunction-associated steatotic liver disease (MASLD). We investigated whether a combined TSH–BMI profile could refine risk stratification and identify lifestyle patterns associated with favorable outcomes in adults with MASLD.
Methods: We analyzed 4,225 adults with MASLD from NHANES III, stratified into three age groups: young (<40 years; n = 1,445), midlife (40–60 years; n = 1,616), and elderly (>60 years; n = 1,164). The TSH cutoff that best stratified all-cause mortality was identified using univariable Cox analysis. Among participants with favorable TSH levels, restricted cubic spline models estimated the BMI range associated with lower mortality. Associations between lifestyle patterns and prognosis were assessed across TSH–BMI profiles.
Results: Favorable ranges were TSH ≤ 1.4 mIU/L and BMI 24.5–27.5 kg/m2 in young participants (hazard ratio [HR] = 0.37, 95% confidence interval [CI]: 0.16–0.84, p = 0.017); TSH ≥ 1.0 mIU/L and BMI 25.0–29.5 kg/m2 in midlife participants (HR = 0.52, 95% CI: 0.32–0.82, p = 0.005); and TSH ≤ 2.1 mIU/L and BMI 28.9–33.9 kg/m2 in elderly participants (HR = 0.48, 95% CI: 0.34–0.66, p < 0.001). Higher diet quality was associated with better prognosis across age groups (all p < 0.05). Appropriate moderate-to-vigorous exercise was associated with better survival in specific subpopulations, including midlife participants with unfavorable TSH and BMI ranges (≥5 times/week). Sensitivity analyses were consistent.
Conclusion: The TSH–BMI profile may inform mortality risk assessment and identification of favorable lifestyle patterns in adults with MASLD.
Related
- Association between grip strength and cause-specific mortality in metabolic dysfunction-associated steatotic liver disease
- Efficacy and safety of GLP-1 receptor agonists in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) : A systematic review and meta-analysis
- Efficacy of plant extracts for metabolic dysfunction-associated steatotic liver disease: a network meta-analysis
- Tirzepatide use in adolescents with metabolic dysfunction‐associated steatotic liver disease (MASLD): A case series
- Functional and Metabolic Correlates of Age- and Sex-Normalized Handgrip Strength in Children with Metabolic Dysfunction-Associated Steatotic Liver Disease
BibTeX
@article{xu2026thyroidstimulating,
title = {{Thyroid-stimulating hormone–body mass index profile and mortality in metabolic dysfunction-associated steatotic liver disease}},
author = {Jie Xu and Jun-Zhe Yi and Ping Chen and Yu-Nan Zhang and Jiong-Liang Wang and Xin-Tong Wu and Yi-Min Zhang and Song Chen and Wei-Jie Wu and Zu-Qing Gao and Zi-Xi Ou-Yang and Gen-Jun Tan and Yu-Jia Song and Hai-Jing Deng and Meng He and Yi-Quan Jiang and Qi-Feng Chen and Ming Zhao and Ning Lyu},
journal = {ILIVER},
year = {2026},
month = oct,
doi = {10.1016/j.iliver.2026.100279},
url = {https://doi.org/10.1016/j.iliver.2026.100279},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Thyroid-stimulating hormone–body mass index profile and mortality in metabolic dysfunction-associated steatotic liver disease
AU - Jie Xu
AU - Jun-Zhe Yi
AU - Ping Chen
AU - Yu-Nan Zhang
AU - Jiong-Liang Wang
AU - Xin-Tong Wu
AU - Yi-Min Zhang
AU - Song Chen
AU - Wei-Jie Wu
AU - Zu-Qing Gao
AU - Zi-Xi Ou-Yang
AU - Gen-Jun Tan
AU - Yu-Jia Song
AU - Hai-Jing Deng
AU - Meng He
AU - Yi-Quan Jiang
AU - Qi-Feng Chen
AU - Ming Zhao
AU - Ning Lyu
PY - 2026
DA - 2026/10/12
JO - ILIVER
DO - 10.1016/j.iliver.2026.100279
UR - https://doi.org/10.1016/j.iliver.2026.100279
AB - Background and aims: Thyroid-stimulating hormone (TSH) and body mass index (BMI) are potential prognostic factors in metabolic dysfunction-associated steatotic liver disease (MASLD). We investigated whether a combined TSH–BMI profile could refine risk stratification and identify lifestyle patterns associated with favorable outcomes in adults with MASLD. Methods: We analyzed 4,225 adults with MASLD from NHANES III, stratified into three age groups: young (<40 years; n = 1,445), midlife (40–60 years; n = 1,616), and elderly (>60 years; n = 1,164). The TSH cutoff that best stratified all-cause mortality was identified using univariable Cox analysis. Among participants with favorable TSH levels, restricted cubic spline models estimated the BMI range associated with lower mortality. Associations between lifestyle patterns and prognosis were assessed across TSH–BMI profiles. Results: Favorable ranges were TSH ≤ 1.4 mIU/L and BMI 24.5–27.5 kg/m2 in young participants (hazard ratio [HR] = 0.37, 95% confidence interval [CI]: 0.16–0.84, p = 0.017); TSH ≥ 1.0 mIU/L and BMI 25.0–29.5 kg/m2 in midlife participants (HR = 0.52, 95% CI: 0.32–0.82, p = 0.005); and TSH ≤ 2.1 mIU/L and BMI 28.9–33.9 kg/m2 in elderly participants (HR = 0.48, 95% CI: 0.34–0.66, p < 0.001). Higher diet quality was associated with better prognosis across age groups (all p < 0.05). Appropriate moderate-to-vigorous exercise was associated with better survival in specific subpopulations, including midlife participants with unfavorable TSH and BMI ranges (≥5 times/week). Sensitivity analyses were consistent. Conclusion: The TSH–BMI profile may inform mortality risk assessment and identification of favorable lifestyle patterns in adults with MASLD.
SN - 2772-9478
ER -