Metabolic characteristics of patients with MetALD: Caveats of a new definition

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2024-08-17 DOI:10.1111/liv.16034

Erin Petrie, Meagan Gray, Fernando Bril

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Abstract

Background and Aims

Recently, a new entity was introduced, MetALD, which includes patients with metabolic dysfunction-associated steatotic liver disease (MASLD), who consume moderate amounts of alcohol. However, little is known regarding the metabolic and clinical characteristics of these patients.

Methods

Data from the National Health and Nutrition Examination Surveys 2017–2020 was used. Participants without valid transient elastography (TE) measurements, incomplete alcohol consumption report, or with alternative etiologies of liver steatosis were excluded.

Results

A total of 6901 patients were included in the study, of which 106 (1.5%) had MetALD. Overall, MetALD patients showed a metabolic profile that was more similar to patients with alcohol related liver disease (ALD) than MASLD. Specifically, while patients with MetALD showed values in-between MASLD and ALD for body mass index (BMI), aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyltransferase (GGT) and haemoglobin A1c, they had similar high-density lipoprotein cholesterol (HDL-C), blood pressure, prevalence of diabetes and insulin resistance to ALD patients. Increasing alcohol consumption was associated with lower insulin resistance and A1c and higher triglycerides, HDL-C and blood pressure. Moreover, while AST, ALT and GGT increased with alcohol consumption, this did not translate into worse hepatic steatosis or liver fibrosis by TE.

Conclusions

MetALD patients share some characteristics with MASLD, but they resemble ALD patients more, especially after adjusting for BMI. Alcohol consumption produces a dissociation between insulin resistance and some cardiometabolic risk factors (blood pressure and HDL-C), which may make the current classification of patients challenging.

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MetALD 患者的代谢特征：新定义的注意事项。

背景和目的：最近出现了一个新的实体--MetALD，其中包括适量饮酒的代谢功能障碍相关性脂肪性肝病（MASLD）患者。然而，人们对这些患者的代谢和临床特征知之甚少：采用 2017-2020 年全国健康与营养调查的数据。结果：共纳入 6901 名患者：研究共纳入 6901 名患者，其中 106 人（1.5%）患有 MetALD。总体而言，与MASLD相比，MetALD患者的代谢特征更类似于酒精相关性肝病（ALD）患者。具体来说，虽然 MetALD 患者的体重指数 (BMI)、天冬氨酸转氨酶 (AST)、丙氨酸转氨酶 (ALT)、γ 谷氨酰转移酶 (GGT) 和血红蛋白 A1c 值介于 MASLD 和 ALD 之间，但他们的高密度脂蛋白胆固醇 (HDL-C)、血压、糖尿病患病率和胰岛素抵抗与 ALD 患者相似。饮酒量增加与胰岛素抵抗和 A1c 降低以及甘油三酯、高密度脂蛋白胆固醇和血压升高有关。此外，虽然谷草转氨酶（AST）、谷丙转氨酶（ALT）和谷草转氨酶（GGT）会随着饮酒量的增加而升高，但这并不会导致肝脏脂肪变性或肝纤维化的恶化：结论：MetALD 患者与 MASLD 患者有一些共同特征，但他们更像 ALD 患者，尤其是在调整体重指数后。饮酒会导致胰岛素抵抗和某些心脏代谢风险因素（血压和高密度脂蛋白胆固醇）之间的分离，这可能使目前对患者的分类具有挑战性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.