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文献速递2 型糖尿病长期管理

MASLD患者肌肉/脂肪比与长期预后的非线性关联

Nonlinear Associations of Body Muscle‐to‐Fat Ratio With Long‐Term Prognosis in MASLD
RSS 订阅 · Diabetes, Obesity and Metabolism · 2026-10-20

结果显示BMFR与各结局呈显著非线性关联，且存在性别特异性拐点。BMFR可能提供超越BMI的身体成分信息。

要点

  • MASLD中BMFR与肝脏及心血管预后呈非线性关联，存在性别特异性拐点。
  • 女性BMFR与各结局关联多为U型，男性心血管及死亡结局更接近L型。
  • BMFR可作为BMI之外补充反映身体成分平衡的指标。

核心结论

  • 在MASLD中，BMFR与肝脏相关事件和心血管结局存在关联，女性多为U型，男性肝脏事件为U型、心血管及死亡结局更接近L型。

研究设计与样本

  • BMFR通过生物电阻抗分析计算为全身肌肉量除以全身脂肪量。
  • 采用限制性立方样条、阈值效应及两段Cox模型分析，并校正BMI及其他混杂因素。

主要发现

  • BMFR与所有结局均呈显著非线性关联，且各结局存在性别特异性拐点。

关键数值与推荐

  • 肝脏事件BMFR阈值：男性2.82，女性1.45；低于阈值时每增加1个SD，男性HR=0.86（95%CI 0.75–0.98），女性HR=0.72（95%CI 0.63–0.83）。
  • 肝脏事件高于阈值时每增加1个SD，男性HR=1.21（95%CI 1.07–1.36），女性HR=1.33（95%CI 1.11–1.59）。
  • 心血管事件BMFR阈值：男性2.03，女性1.48；低于阈值时男性HR=0.77（95%CI 0.70–0.85），女性HR=0.85（95%CI 0.81–0.89）。
  • 心血管事件高于阈值时男性关联不显著，女性HR=1.19（95%CI 1.09–1.30）。
  • 心血管死亡和全因死亡的性别特异性非线性模式与心血管事件相似。

临床怎么用

  • 对MASLD患者评估BMFR可能补充BMI以外的身体成分信息，辅助预后判断。

局限性

  • 研究结果属探索性，需进一步研究验证。

以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。

原文

ABSTRACT Background As weight-loss therapies are increasingly incorporated into clinical practice for MASLD, assessing body composition has become increasingly important. Body muscle-to-fat ratio (BMFR) may provide an intuitive and integrated measure of body composition balance, but its association with long-term prognosis in MASLD remains unclear. Methods We studied 83 006 UK Biobank participants with MASLD. BMFR was calculated as whole-body muscle mass divided by whole-body fat mass using bioelectrical impedance analysis. Restricted cubic spline, threshold-effect and two-piecewise Cox models assessed associations with liver-related events (LREs), cardiovascular events (CVEs), cardiovascular mortality and all-cause mortality, adjusting for BMI and other confounders. Results BMFR showed significant non-linear associations with all outcomes. Sex-specific inflection points were identified for each outcome. For LREs, the thresholds were 2.82 in men and 1.45 in women; below these thresholds, each 1-SD increase in BMFR was associated with a lower risk of LREs (men: HR = 0.86, 95% CI: 0.75–0.98; women: HR = 0.72, 95% CI: 0.63–0.83), whereas above them it was associated with a higher risk (men: HR = 1.21, 95% CI: 1.07–1.36; women: HR = 1.33, 95% CI: 1.11–1.59). For CVEs, the thresholds were 2.03 in men and 1.48 in women; below these thresholds, each 1-SD increase in BMFR was associated with a lower risk in both sexes (men: HR = 0.77, 95% CI: 0.70–0.85; women: HR = 0.85, 95% CI: 0.81–0.89), whereas above them the association was not significant in men but was associated with a higher risk in women (HR = 1.19, 95% CI: 1.09–1.30). Cardiovascular mortality and all-cause mortality showed sex-specific non-linear patterns similar to those observed for CVEs. Conclusions In MASLD, BMFR was associated with liver-related and cardiovascular outcomes. Associations were generally U-shaped in women; in men, they were U-shaped for LREs and closer to L-shaped for cardiovascular outcomes and mortality. BMFR may provide complementary information on body composition beyond BMI. Further studies are needed to validate these exploratory findings.

来源：Diabetes, Obesity and Metabolism，查看原文。版权归原作者所有。

引用

  1. Diabetes, Obesity and Metabolism：Nonlinear Associations of Body Muscle‐to‐Fat Ratio With Long‐Term Prognosis in MASLD
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供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。