Early screening of non-alcoholic fatty liver disease (NAFLD) is critical for early diagnosis and management. The disease was renamed and its diagnostic criteria revised as metabolic-associated FLD (MAFLD) in 2020 and further updated to metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. This study evaluated the predictive performance and clinical feasibility of non-invasive diagnostic indicators across the NAFLD, MAFLD and MASLD diagnostic criteria.

Cross-sectional study.

Health Management Centre in China.

A total of 5810 participants aged ≥18 years were enrolled. Individuals with missing laboratory data, imaging results or self-reported information were excluded.

Disease-specific indicators included Fatty Liver Index (FLI), Hepatic Steatosis Index and Zhejiang University index (ZJU). Non-disease-specific indicators included lipid accumulation product (LAP), Visceral Adiposity Index and the Triglyceride and Glucose Index. Subgroup analysis was performed by gender and Body Mass Index (BMI).

The area under the receiver operating characteristic curve (AUROC) for all six non-invasive indicators exceeded 0.7. FLI showed the optimal predictive performance across the three criteria (NAFLD-AUROC: 0.802, MAFLD-AUROC: 0.847 and MASLD-AUROC: 0.811), with comparable performance observed for ZJU (0.797, 0.838 and 0.809, respectively). Pairwise z-tests demonstrated a significant difference between FLI and ZJU for MAFLD (p0.05). Subgroup analyses revealed that ZJU performed better in males (NAFLD-AUROC: 0.790, MAFLD-AUROC: 0.839 and MASLD-AUROC: 0.803), while FLI was superior in females (NAFLD-AUROC: 0.832, MAFLD-AUROC: 0.838 and MASLD-AUROC: 0.838) and in participants who were overweight (NAFLD-AUROC: 0.709, MAFLD-AUROC: 0.765 and MASLD-AUROC: 0.709). LAP exhibited the highest predictive efficacy in the normal BMI subgroup (NAFLD-AUROC: 0.758, MAFLD-AUROC: 0.804 and MASLD-AUROC: 0.796).

FLI exhibited the highest predictive efficacy across all diagnostic criteria, and ZJU showed comparable performance. Considering diagnostic accuracy and clinical practicality, ZJU is recommended as a favourable, non-invasive tool for population-based screening in the Chinese population.

This study aims to examine the relationship between alcohol consumption patterns and hypertension in high-altitude populations. Additionally, it seeks to assess the mediating effects of metabolic factors on this association.

Cross-sectional study.

A subproject of a national survey conducted in high-altitude regions of Tibet, China.

A total of 53 460 residents aged 35–75 years were selected using multistage cluster sampling.

Hypertension was defined as a systolic blood pressure ≥140 mm Hg and/or a diastolic blood pressure ≥90 mm Hg, self-reported physician-diagnosed hypertension or current use of antihypertensive medications.

Multivariate logistic regression analyses were used to assess the association between different frequencies of alcohol consumption and hypertension. Simple and parallel multiple multicategorical mediation analyses were performed to estimate the individual and combined mediation effects of dyslipidaemia and obesity.

Finally, 50 044 participants were included in the analysis, with a hypertension prevalence of 42.97%. Among them, 41.3% were males, and the mean age was 51.12 years. Compared with non-drinkers, occasional alcohol consumption was not significantly associated with hypertension in the overall population. However, in subgroup analysis, it was linked to a 12% increase in odds among males (OR 1.12, 95% CI 1.02 to 1.24) and an 11% decrease among females (OR 0.89, 95% CI 0.81 to 0.97). The odds of hypertension rose significantly by 1.25 (95% CI 1.15 to 1.36), 1.23 (95% CI 1.12 to 1.36) and 1.51 (95% CI 1.37 to 1.65) times in the groups consuming alcohol two to four times a month, two to three times a week and ≥4 times a week, respectively. The indirect effects of these mediators were evident in the light-to-moderate alcohol consumption group but not in the heavy drinking group, a pattern that was also confirmed in sensitivity analyses.

This large-scale study underscores that the impact of occasional drinking on hypertension varies by gender, while consistent associations between frequent alcohol consumption and a higher prevalence of hypertension were observed. Given the differing mediating effects of metabolic abnormalities across individuals with varying alcohol consumption patterns, tailored interventions should be implemented. These findings provide valuable evidence to inform public health strategies to prevent hypertension.