Work

Thyroid-stimulating hormone–body mass index profile and mortality in metabolic dysfunction-associated steatotic liver disease

Year: 2026

Type: article

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/m 2 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/m 2 in midlife participants (HR = 0.61, 95% CI: 0.32–0.82, p = 0.005); and TSH ≤ 2.1 mIU/L and BMI 28.9–33.9 kg/m 2 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.

Source: iLiver

DOI: 10.1016/j.iliver.2026.100279