MASLD/MetALD and mortality in individuals with any cardio-metabolic risk factor: A population-based study with 26.7
Minsun Kwak1, Hyun-Seok Kim2, Zhenghui Gordon Jiang3
1Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
Background And Aims:
A new term, metabolic dysfunction-associated steatotic liver disease (MASLD), has been proposed by a multi-society expert panel. However, it remains unclear whether hepatic steatosis per se in MASLD contributes to an increased risk of mortality in individuals with any cardio-metabolic risk factor (CMRF), which is also a significant risk factor for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the "MASLD/MetALD" and "no steatotic liver disease (SLD)" groups in individuals with any CMRF.
Approach And Results:
A population-based cohort study was conducted using 10,750 participants of the Third National Health and Nutrition Examination Survey. All-cause and cause-specific (cardiovascular, cancer, diabetes, and liver) mortality risks were compared between the "MASLD," "MetALD," and "no SLD" groups using the Cox proportional hazards model with complex survey design weights, adjusted for confounders. Over 26 years, the "MASLD" group did not show significantly increased all-cause (adjusted HR 1.04[95% CI: 0.95-1.14], p = 0.413), cardiovascular (0.88 [0.75-1.04], p = 0.139), or cancer (1.06[0.84-1.33], p = 0.635) mortality risk compared to the "no SLD" group in individuals with any CMRF. The MetALD group was associated with increased all-cause (1.41 [1.05-1.89], p = 0.022), cancer (2.35 [1.33-4.16], p = 0.004), and liver (15.04 [2.96-76.35], p = 0.002) mortality risk compared with the no SLD group. This trend was more pronounced in the MetALD group with advanced fibrosis assessed by Fibrosis-4 (FIB-4).
Conclusions:
In individuals with CMRF, the presence of steatotic liver disease (MASLD) alone did not increase the risk of mortality, except in cases with more alcohol consumption (MetALD). Therefore controlling metabolic risk factors and reducing alcohol consumption in people with MASLD or MetALD will be crucial steps to improve long-term health outcomes.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) alone did not increase mortality risk in individuals with cardio-metabolic risk factors. However, alcohol-related fatty liver disease (MetALD) was linked to higher mortality, especially with advanced fibrosis.
Area of Science:
- Hepatology
- Cardio-metabolic Health
- Public Health
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a newly proposed term for fatty liver disease linked to metabolic risk factors.
- Cardio-metabolic risk factors (CMRF) are independently associated with increased mortality.
- The independent contribution of hepatic steatosis in MASLD to mortality risk in individuals with CMRF is not well-established.
Purpose of the Study:
- To compare all-cause and cause-specific mortality between individuals with MASLD/MetALD and those without steatotic liver disease (SLD).
- To investigate mortality risks in individuals with at least one CMRF.
- To assess the impact of fibrosis severity in MetALD on mortality outcomes.
Main Methods:
- A population-based cohort study utilizing data from 10,750 participants of the Third National Health and Nutrition Examination Survey.
- Cox proportional hazards models with complex survey design weights were employed to compare mortality risks.
- Analyses were adjusted for relevant confounders over a 26-year follow-up period.
Main Results:
- The MASLD group showed no significant increase in all-cause, cardiovascular, or cancer mortality compared to the no SLD group among individuals with CMRF.
- The MetALD group demonstrated significantly increased all-cause, cancer, and liver mortality compared to the no SLD group.
- These adverse outcomes in the MetALD group were more pronounced in individuals with advanced fibrosis (FIB-4).
Conclusions:
- Hepatic steatosis alone (MASLD) does not elevate mortality risk in individuals with CMRF.
- Alcohol-related fatty liver disease (MetALD) is associated with increased mortality, particularly when advanced fibrosis is present.
- Managing metabolic risk factors and reducing alcohol consumption are critical for improving long-term outcomes in patients with MASLD and MetALD.
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