Magnesium Depletion Score and Mortality in Individuals with Metabolic Dysfunction Associated Steatotic Liver Disease over a Median Follow-Up of 26 Years

Methods: A total of 3802 participants with MASLD or MetALD were followed up over a median of 26 years in the National Health and Nutrition Examination Survey (NHANES) III cohort. The MDS was calculated by aggregating four factors influencing the reabsorption capability of the kidneys. The associations between MDS and all-cause, CVD, and cancer mortality were quantified using Cox proportional hazard regression models.

Results: In the combined MASLD + MetALD cohort, a higher MDS (>2) was associated with increased all-cause mortality (HR, 2.52; 95%CI, 1.77-3.61; -trend < 0.0001) and CVD mortality (HR, 3.01; 1.87-4.86; -trend < 0.0001) compared to MDS = 0; this association became stronger among participants who did not meet the estimated average requirement level of Mg intake (2.72; 1.69-4.37; -trend = 0.0014) and those with a Fibrosis-4 index (FIB-4) < 1.3 (2.95; 1.69-5.15; -trend = 0.0006).

Conclusions: In individuals with MASLD or MetALD, higher MDS, indicative of worse global Mg status, was associated with an increased risk of all-cause and CVD mortality. Correcting global Mg deficiency in high-risk MASLD/MetALD patients may have long-term health benefits.