{
  "abstract": "Background Metabolic-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease affecting approximately a third of the global population. Early identification is critical for timely intervention, yet effective screening tools remain limited. The American Heart Association’s Life’s Simple 7 (LS7), originally developed to assess cardiovascular health, captures several metabolic domains that overlap with the diagnostic criteria of MASLD. Consequently, observed associations between LS7 and MASLD are expected to partly reflect shared metabolic components rather than independent risk prediction.Methods We analysed data from 3204 participants undergoing screening colonoscopy in the Salzburg Colon Cancer Prevention Initiative (Sakkopi). LS7 was derived from seven modifiable lifestyle factors (smoking, body mass index, blood pressure, cholesterol, fasting glucose, physical activity and diet). MASLD was assessed using abdominal ultrasonography, while liver fibrosis was evaluated through non-invasive markers (Aspartate Aminotransferase to Platelet Ratio Index and transient elastography). Poisson regression with robust SEs was used to estimate risk ratios (RRs) for MASLD and liver fibrosis across LS7 categories (poor: 0–4, intermediate: 5–9, ideal: 10–14), adjusting for age, sex and socioeconomic status.Results MASLD prevalence was highest in individuals with poor LS7 (82%) compared with those with intermediate (47%) and ideal (16%) scores. Higher LS7 was significantly associated with a lower risk of MASLD (RR 0.80; 95% CI 0.79 to 0.82; p<0.001) and liver fibrosis after adjustment for confounders.Conclusion LS7 showed a strong association with MASLD and hepatic steatosis, while associations with non-invasive fibrosis markers were weaker and marker-dependent, underscoring the close interplay between cardiometabolic health and liver disease. Future studies should evaluate whether changes in LS7 over time are associated with longitudinal changes in hepatic steatosis and fibrosis-related outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, Saint John of God Hospital, Salzburg, Austria"
      ],
      "name": "Hannah Hofer"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, General Hospital Oberndorf, Salzburg, Austria"
      ],
      "name": "Sarah Wernly"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria"
      ],
      "name": "Georg Semmler"
    },
    {
      "affiliations": [
        "Institute of General Practice, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Maria Flamm"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, General Hospital Oberndorf, Salzburg, Austria"
      ],
      "name": "Andreas Völkerer"
    },
    {
      "affiliations": [
        "Department of Surgery, Salzburger Landeskliniken Universitätsklinikum Salzburg, Salzburg, Austria"
      ],
      "name": "Franz Singhartinger"
    },
    {
      "affiliations": [
        "Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany"
      ],
      "name": "Christian Jung"
    },
    {
      "affiliations": [
        "Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany"
      ],
      "name": "Ralf Erkens"
    },
    {
      "affiliations": [
        "Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Mathias Ausserwinkler"
    },
    {
      "affiliations": [
        "Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Elmar Aigner"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, General Hospital Oberndorf, Salzburg, Austria"
      ],
      "name": "Christian Datz"
    },
    {
      "affiliations": [
        "Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Bernhard Wernly"
    }
  ],
  "title": "Association of Life’s Simple 7 with metabolic-associated steatotic liver disease and non-invasive fibrosis markers",
  "uid": "842df61e-aa2f-5c1c-9aa4-5fb934061f55"
}