Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease

Table 1 Cardiovascular-kidney-metabolic syndrome stages

Stages	Definition
Stage 0: No CKM risk factors	Individuals with normal BMI and waist circumference, normoglycemia, normotension, a normal lipid profile, and no evidence of CKD or subclinical or clinical CVD
Stage 1: Excess or dysfunctional adiposity	Individuals with overweight/obesity, abdominal obesity, or dysfunctional adipose tissue, without the presence of other metabolic risk factors or CKD. BMI ≥ 25 kg/m2 (or ≥ 23 kg/m2 if Asian ancestry), waist circumference ≥ 88/102 cm in women/men (or if Asian ancestry ≥ 80/90 cm in women/men), or fasting blood glucose ≥ 100-124 mg/dL or HbA1c between 5.7% and 6.4%
Stage 2: Metabolic risk factors and CKD	Individuals with metabolic risk factors, hypertriglyceridemia (≥ 135 mg/dL), hypertension, MetS, diabetes, or CKD
Stage 3: Subclinical CVD in CKM	Subclinical ASCVD or subclinical HF among individuals with excess/dysfunctional adiposity, other metabolic risk factors, or CKD. Subclinical ASCVD to be principally diagnosed by coronary artery calcification (subclinical atherosclerosis by coronary catheterization/computed tomography angiography also meets criteria). Subclinical HF diagnosed by elevated cardiac biomarkers (NT-proBNP ≥ 125 pg/mL, hs-troponin T ≥ 14 ng/L for women and ≥ 22 ng/L for men, hs-troponin I ≥ 10 ng/L for women and ≥ 12 ng/L for men) or by echocardiographic parameters, with a combination of the 2 indicating highest HF risk. Risk equivalents of subclinical CVD. Very high-risk CKD (stage G4 or G5 CKD or very high risk per KDIGO classification). High predicted 10-year CVD risk
Stage 4: Clinical CVD in CKM	Clinical CVD (coronary heart disease, HF, stroke, peripheral artery disease, atrial fibrillation) among individuals with excess/dysfunctional adiposity, other CKM risk factors, or CKD. Stage 4a: No kidney failure. Stage 4b: Kidney failure present

CKM: Cardiovascular-kidney-metabolic syndrome; CKD: Chronic kidney disease; CVD: Cardiovascular disease; BMI: Body mass index; HbA1c: Glycated hemoglobin; MetS: Metabolic syndrome; ASCVD: Atherosclerotic cardiovascular disease; HF: Heart failure; NT-proBNP: N-terminal pro-B-type natriuretic peptide; KDIGO: Kidney Disease: Improving Global Outcomes.