Association of the Modified Endothelial Activation and Stress Index with MASLD and Liver Fibrosis: Effect Modification by Magnesium Intake

Background/Aims: Few studies have reported the effect of magnesium status on the endothelial dysfunction–related risk for the development of MASLD and liver fibrosis. The current study aimed to explore the association of modified endothelial activation and stress index (mEASIX) with metabolic dysfunction–associated steatotic liver disease (MASLD) and liver fibrosis and to examine the effect of magnesium intake on this association. Materials and Methods: A cross-sectional study was conducted using data from 5960 participants in the National Health and Nutrition Examination Survey 2017-2020. The mEASIX was calculated based on lactate dehydrogenase levels, high-sensitivity C-reactive protein levels, and platelet counts. Metabolic dysfunction–associated steatotic liver disease was defined as the presence of hepatic steatosis along with at least one of the 5 cardiometabolic risk factors. Liver fibrosis was defined as a liver stiffness measurement ≥ 8.0 kPa. Magnesium (Mg) intake was assessed using the 24-hour dietary recall data. Multivariate logistic regression analyses were performed to examine the associations of mEASIX with MASLD and liver fibrosis. Results: The mEASIX was positively associated with MASLD and liver fibrosis (MASLD: odds ratio [OR] in Q2 = 1.62, Q3 = 2.38, and Q4 = 2.70; liver fibrosis: OR in Q3 = 1.84 and Q4 = 2.73; all P < .05). The mEASIX revealed nonlinear relationships with MASLD and liver fibrosis. A significant interaction between magnesium intake and mEASIX was observed in relation to MASLD. Stratified analyses further demonstrated that the association between high mEASIX (≥1.2) and the risk of MASLD and liver fibrosis was more pronounced among participants with low magnesium intake compared to those with high magnesium intake. Conclusion: The current study demonstrated positive nonlinear associations of mEASIX with MASLD and liver fibrosis. Low magnesium intake may exacerbate this endothelial dysfunction–related risk for MASLD and liver fibrosis. Cite this article as: Li X, Huang Z. Association of the modified endothelial activation and stress index with MASLD and liver fibrosis: Effect modification by magnesium intake. Turk J Gastroenterol. Published online April 21, 2026. doi: 10.5152/tjg.2026.25591.