Chronic stress and unhealthy behaviours were associated with increased all cause and cardiovascular mortality among adults with metabolic dysfunction associated steatotic liver disease (MASLD), with the greatest risks observed in those experiencing both high physiological stress burden and poor health behaviours, according to a study of 9,761 participants.
Researchers investigated whether allostatic load, an indicator of cumulative physiological stress, and health behaviours were independently and jointly associated with mortality among adults with and without MASLD. The findings highlighted the potential importance of considering both factors when assessing prognosis in patients with the condition.
The study included 9,761 participants from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Of these, 3,158 participants (32.4%) were classified as having MASLD.
Researchers assessed allostatic load using 10 physiological biomarkers. Health behaviours were evaluated through diet, nicotine exposure, physical activity and sleep duration. Participants were followed for a median of 7.42 years, during which 922 deaths occurred, including 268 cardiovascular deaths.
The researchers used statistical models to investigate associations between allostatic load, health behaviour scores and mortality, adjusting for relevant demographic and health related factors.
Higher allostatic load and poorer health behaviours were independently associated with increased all cause and cardiovascular mortality in participants with and without MASLD.
Among participants with MASLD, those with high allostatic load and poor health behaviour scores experienced the greatest mortality risks compared with those with low allostatic load and health behaviour scores of at least 50.
The researchers concluded that high allostatic load and unhealthy behaviours were associated with increased all-cause and cardiovascular mortality among adults with MASLD. However, future large-scale cohort studies using medical record data from diverse populations are warranted to validate these associations.
Reference
Hong D et al. Allostatic load, unhealthy behaviours, and mortality risk among participants with and without metabolic dysfunction–associated steatotic liver disease. European Gastroenterol J.2026. DOI; 10.1097/MEG.0000000000003290.
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