Identifying and Treating Metabolic Dysfunction-Associated Steatotic Liver Disease Among At-Risk Veterans

Area of Science:

• Public Health
• Hepatology
• Internal Medicine

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) presents diagnostic and risk-stratification challenges.
• MASLD prevalence and risk factors are increasing public health concerns.

Purpose of the Study:

• To assess MASLD risk factor prevalence in Veterans Health Administration (VA) care.
• To identify factors associated with MASLD diagnosis.
• To examine the link between MASLD diagnosis and healthcare utilization.

Main Methods:

• Identified veterans with MASLD risk factors (obesity, diabetes, dyslipidemia) using ICD-10 codes (2019-2022).
• Employed multivariable logistic regression and propensity score-adjusted models.
• Analyzed associations with MASLD/cirrhosis diagnosis and receipt of elastography, specialty care, weight management (MOVE!), and GLP-1 analogs.

Main Results:

• 45% of ~9 million veterans had MASLD risk factors; 6% were diagnosed with MASLD or cirrhosis.
• Diagnosed individuals were younger, had more metabolic risk factors, higher alcohol use disorder rates, and elevated FIB-4/ALT.
• MASLD diagnosis correlated with increased MOVE!, specialty care, and GLP-1 analog prescriptions.

Conclusions:

• Underdiagnosis of MASLD and low rates of staging elastography were observed in at-risk veterans.
• MASLD diagnosis was associated with improved access to hepatology care and weight loss services.
• Population-based screening and management strategies for MASLD are urgently required.