MASLD in High-Altitude versus Non-High-Altitude Populations: Prevalence, Risk Factors and Predictive Modeling

MASLD in High-Altitude versus Non-High-Altitude Populations: Prevalence, Risk Factors and Predictive Modeling | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article MASLD in High-Altitude versus Non-High-Altitude Populations: Prevalence, Risk Factors and Predictive Modeling Xian Zhang, Ruifang Pu, Jing Liu, Rui He, Chengwan Xu, Xiaopu Ma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8807828/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a global health challenge, and high-altitude environments may affect its prevalence via metabolic disruptions. This retrospective cross-sectional study investigated MASLD’s prevalence, risk factors, and predictive models in high-altitude versus non-high-altitude populations, exploring geographical impacts. Methods: A total of 8,460 participants (5,640 high-altitude, 2,820 non-high-altitude) who underwent health exams were enrolled. Data included demographics, physical parameters, imaging parameters and lab tests. Univariate and multivariate logistic regression was adopted to identify risk factors. Nomograms were developed and validated via ROC, calibration, and decision curve analyses. Results: The overall prevalence of MASLD was 51.52%, significantly higher in the high-altitude group (54.68%) than in the non-high-altitude group (45.21%). Multivariate analysis identified distinct risk profiles: in the high-altitude population, waist circumference (WC), gamma-glutamyl transferase (GGT), and triglycerides (TG) were independent risk factors. In the non-high-altitude population, independent risk factors included fasting plasma glucose (FPG), TG, and WC, while female sex and high-density lipoprotein cholesterol (HDL-C) were protective factors. No significant interaction was found between sex and altitude on MASLD risk. Nomograms incorporating these variables demonstrated good predictive performance, with AUCs of 0.836 (high-altitude, 6 parameters) and 0.885 (non-high-altitude, 8 parameters), and showed favorable clinical utility. Conclusions: This study confirms geographical disparities in MASLD prevalence and risk factor profiles, providing evidence for altitude-specific prevention. Limitations include its retrospective cross-sectional design, sample imbalance, single-center bias and so on. These findings highlight the need for altitude-specific prevention strategies and warrant further validation in future multi-center studies. Metabolic Dysfunction-Associated Steatotic Liver Disease High-altitude environments Nomograms Risk factors Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 May, 2026 Reviewers invited by journal 01 Mar, 2026 Editor invited by journal 12 Feb, 2026 Editor assigned by journal 11 Feb, 2026 Submission checks completed at journal 11 Feb, 2026 First submitted to journal 06 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8807828","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598957430,"identity":"9cb32a19-5d74-49f1-897e-d42333972152","order_by":0,"name":"Xian Zhang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xian","middleName":"","lastName":"Zhang","suffix":""},{"id":598957431,"identity":"7492f595-e2a6-409c-aad7-79dd2ecc3da4","order_by":1,"name":"Ruifang Pu","email":"","orcid":"","institution":"West China Hospital of Sichuan 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Metabolic Dysfunction-Associated Steatotic Liver Disease, High-altitude environments, Nomograms, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-8807828/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8807828/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMetabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a global health challenge, and high-altitude environments may affect its prevalence via metabolic disruptions. This retrospective cross-sectional study investigated MASLD’s prevalence, risk factors, and predictive models in high-altitude versus non-high-altitude populations, exploring geographical impacts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 8,460 participants (5,640 high-altitude, 2,820 non-high-altitude) who underwent health exams were enrolled. Data included demographics, physical parameters, imaging parameters and lab tests. Univariate and multivariate logistic regression was adopted to identify risk factors. Nomograms were developed and validated via ROC, calibration, and decision curve analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe overall prevalence of MASLD was 51.52%, significantly higher in the high-altitude group (54.68%) than in the non-high-altitude group (45.21%). Multivariate analysis identified distinct risk profiles: in the high-altitude population, waist circumference (WC), gamma-glutamyl transferase (GGT), and triglycerides (TG) were independent risk factors. In the non-high-altitude population, independent risk factors included fasting plasma glucose (FPG), TG, and WC, while female sex and high-density lipoprotein cholesterol (HDL-C) were protective factors. No significant interaction was found between sex and altitude on MASLD risk. Nomograms incorporating these variables demonstrated good predictive performance, with AUCs of 0.836 (high-altitude, 6 parameters) and 0.885 (non-high-altitude, 8 parameters), and showed favorable clinical utility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study confirms geographical disparities in MASLD prevalence and risk factor profiles, providing evidence for altitude-specific prevention. 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