MASLD/MetALD and mortality in individuals with any cardio-metabolic risk factor: a population based study with 26.7 years of follow-up

Minsun Kwak; Hyun-Seok Kim; Zhenghui Gordon Jiang; Yee Hui Yeo; Hirsh D Trivedi; Mazen Noureddin; Ju Dong Yang

doi:10.1097/HEP.0000000000000925

MASLD/MetALD and mortality in individuals with any cardio-metabolic risk factor: a population based study with 26.7 years of follow-up

Hepatology. 2024 May 13. doi: 10.1097/HEP.0000000000000925. Online ahead of print.

Authors

Minsun Kwak¹, Hyun-Seok Kim², Zhenghui Gordon Jiang³, Yee Hui Yeo², Hirsh D Trivedi², Mazen Noureddin^{4

5}, Ju Dong Yang²

Affiliations

¹ Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
² Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³ Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Houston Methodist Hospital.
⁵ Department of Houston Research Institute, Houston, Texas, USA.

PMID: 38739848
DOI: 10.1097/HEP.0000000000000925

Abstract

Background 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 are also significant risk factors 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 NHANES III. 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 hazard ratio 1.04[95% confidence interval 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 MetALD group with advanced fibrosis assessed by FIB-4.

Conclusion: 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.