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Beyond clinical outcomes: exploring the relationship between healthy lifestyle adherence and metabolic–hepatic biomarkers in obese individuals with metabolic dysfunction-associated steatotic liver disease (MASLD)

Year: 2026

Type: article

Abstract: Obesity is a major driver of metabolic dysfunction and is strongly associated with the development of metabolic dysfunction-associated steatotic liver disease (MASLD). However, early identification of individuals at increased metabolic and hepatic risk remains challenging. Composite lifestyle scoring provides a practical and integrative approach to capturing multiple modifiable health behaviors simultaneously. This study aimed to examine the association between a Composite Healthy Lifestyle Score (CHLS) and metabolic and hepatic biomarkers among obese adults with MASLD. This cross-sectional study included 340 obese adults aged 18–65 years with MASLD who were recruited from gastroenterology and obesity outpatient clinics. The CHLS was constructed based on four modifiable lifestyle factors: diet quality (Healthy Eating Index-2020), physical activity, smoking status, and body weight status. Participants were categorized into four CHLS quartiles. Anthropometric measurements, biochemical markers (fasting blood glucose, HbA1c, lipid profile, insulin concentrations, and liver enzymes), and blood pressure were assessed. Associations between CHLS and metabolic outcomes were evaluated using multivariable-adjusted models. Higher CHLS was significantly associated with lower fasting blood glucose (adjusted P = 0.039). HbA1c levels also differed significantly across CHLS quartiles after multivariable adjustment (adjusted P = 0.012), although the pattern was non-linear, with the lowest mean HbA1c observed in the second CHLS quartile rather than the highest. Significant inverse associations were also observed between CHLS and alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) concentrations, indicating a more favorable hepatic biomarker profile among participants with greater adherence to healthy lifestyle behaviors. After adjustment for potential confounders, no significant differences were observed in lipid profile parameters or blood pressure across CHLS quartiles. Binary logistic regression analysis demonstrated a significant overall association between CHLS and metabolic syndrome (overall P = 0.013). Compared with the lowest CHLS category, participants in the second and third CHLS categories had significantly lower odds of metabolic syndrome, whereas the association for the highest CHLS category was not statistically significant. Greater adherence to healthy lifestyle behaviors, as reflected by a higher CHLS, was associated with lower fasting blood glucose levels and a more favorable hepatic biomarker profile among obese adults with MASLD. Although HbA1c differed significantly across CHLS categories, its relationship with CHLS was non-linear. No significant associations were observed for lipid profile parameters or blood pressure. Overall, CHLS may represent a practical tool for identifying individuals with less favorable metabolic and hepatic profiles and may support targeted preventive strategies in clinical practice and public health. Not applicable.

Source: BMC Endocrine Disorders

DOI: 10.1186/s12902-026-02506-5