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

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.