Analysis of the Association and Risk Factors Between Metabolic Associated Fatty Liver Disease and Retinal Arteriosclerosis

Purpose To explore the differences in metabolic indicators between patients with metabolic associated fatty liver disease (MAFLD) with and without retinal arteriosclerosis (RAS), and to construct alternative models to analyze the independent risk factors.

Methods A total of 247 patients diagnosed with MAFLD and who underwent fundus photography at Guangdong Provincial People’s Hospital from August 2023 to April 2024 were retrospectively included and divided into two groups based on the presence or absence of RAS. Differences in body mass index (BMI),visceral fat grade, fasting blood glucose, hemoglobin A1c (HbA1c), lipid profile, and uric acid were compared. Logistic regression models were constructed with the presence of RAS as the dependent variable, using traditional lipid indicators and blood pressure (systolic and diastolic) in the baseline model, and alternative indicators plasma atherogenic index (AIP), triglyceride-glucose index (TyG), non-high-density lipoprotein cholesterol, pulse pressure, and mean arterial pressure (MAP) in the alternative model. Independent risk factors were analyzed and the areas under the receiver operating characteristic curves (ROC-AUC) of the two models were compared.

Results The BMI, visceral fat grade, systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1c, and uric acid levels were higher in the RAS group than in the non-RAS group, while high-density lipoprotein cholesterol (HDL-C) levels were lower, with statistically significant differences (P < 0.01). Multivariate analysis showed that visceral fat grade (OR=1.676, P=0.004) and HbA1c odds ratio (OR)=1.218, P=0.037 were independent risk factors in the baseline model, and HDL-C was negatively correlated with RAS (OR=0.136, P=0.012). In the alternative model, visceral fat grade (OR=1.766, P=0.001) AIP (OR=1.519, P=0.022), TyG (OR=1.607, P=0.025), and MAP (OR=1.046, P=0.005) were independent risk factors. The discriminatory power of the two models was similar (AUC: baseline 0.886 vs. alternative 0.885).

Conclusion Visceral fat grade is an independent risk factor for MAFLD with RAS. In the alternative model, AIP, TyG, and MAP were also confirmed as independent risk factors. Clinically, priority should be given to controlling visceral fat while managing lipid metabolism, insulin resistance, and blood pressure (especially MAP) to reduce the risk of RAS in MAFLD patients.