Prevalence, severity and determinants of steatotic liver disease among individuals with metabolic and alcohol risk from the community

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2025-07-05 DOI:10.1016/j.jhep.2025.06.020

Camilla Dalby Hansen, Johanne Kragh Hansen, Mads Israelsen, Peter Andersen, Laura Maarit Pikkupeura, Katrine Prier Lindvig, Sara Elizabeth Stinson, Helle Lindholm Schnefeld, Julie Tellerup, Maria Fogt, Nikolaj Torp, Maria Kjærgaard, Katrine Tholstrup Bech, Katrine Holtz Thorhauge, Stine Johansen, Ida Spedtsberg, Emil Deluran, Ida Falk Villesen, Sönke Detlefsen, Torben Hansen, Maja Thiele

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引用次数: 0

Abstract

Background & Aims

Individuals with steatotic liver disease (SLD) are affected by metabolic dysfunction and/or high alcohol consumption; however, the prevalence of SLD in at-risk individuals remains underexplored. In at-risk individuals, we aimed to investigate the prevalence and severity of SLD and subclasses: metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD)

Methods

Between Oct 2017 and Nov 2022, citizens aged 30-75 years were recruited 1:1 into: a) Metabolic cohort with BMI >30 kg/m² and/or type 2 diabetes without prolonged increased alcohol consumption, b) Alcohol cohort with ongoing/prior increased alcohol consumption. We assessed liver steatosis by controlled attenuation parameter (CAP), liver fibrosis by liver stiffness measurements (LSM) and performed liver biopsies in participants with LSM ≥8 kPa.

Results

We included 3,123 participants; 1,599 in the metabolic cohort and 1,524 in the alcohol cohort. In total, 2,197 (70%) were diagnosed with SLD:1,603 (51%) with MASLD, 398 (13%) with MetALD, and 196 (6.3%) with ALD. Of 307 (9.8%) with LSM ≥8 kPa, 169 underwent liver biopsy (55%). In the metabolic cohort, 1,237 (77%) had SLD, 147 (9.2%) had LSM ≥8 kPa, and 24 (1.5%) had biopsy-confirmed advanced liver fibrosis. In the alcohol cohort, 960 (63%) had SLD, 160 (10.5%) had LSM ≥8 kPa, and 46 (3.1%) had biopsy-confirmed advanced liver fibrosis. Across subclasses, ALD demonstrated highest liver disease severity (LSM ≥8 kPa: 25%; biopsy-confirmed advanced fibrosis: 8%), and severity was comparable between MASLD and MetALD (LSM ≥8 kPa: 12%, biopsy-confirmed advanced fibrosis: 3%).

Conclusions

Among individuals with cardiometabolic and/or alcohol risk factors, 70% had SLD, 10% had elevated liver stiffness, and 2% had biopsy-confirmed advanced liver fibrosis.Clinicaltrials.gov: NCT03308916

Impact and implications

Steatotic liver disease (SLD) remains underdiagnosed in the general population. This study provides new population-based data on its prevalence and severity among individuals with metabolic and/or alcohol-related risk. These findings are relevant to clinicians, researchers, and public health planners, as prevalence data are essential to inform evolving screening strategies. Methodological limitations, including the cross-sectional design and limited generalizability, should be considered when interpreting the results.

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社区中有代谢和酒精风险个体中脂肪变性肝病的患病率、严重程度和决定因素

背景,脂肪变性肝病（SLD）患者受代谢功能障碍和/或高酒精消耗的影响；然而，在高危人群中，SLD的患病率仍未得到充分研究。在高危人群中，我们旨在调查SLD的患病率和严重程度以及亚类：代谢功能障碍相关脂肪变性肝病（MASLD）、代谢和酒精相关肝病（MetALD）和酒精相关肝病（ALD）。方法在2017年10月至2022年11月期间，30-75岁的公民以1:1的比例被招募到：a) BMI≤30 kg/m2和/或2型糖尿病的代谢组，没有长期增加的饮酒量；b)酒精组，持续或既往增加的饮酒量。我们通过控制衰减参数（CAP）评估肝脂肪变性，通过肝刚度测量（LSM）评估肝纤维化，并对LSM≥8 kPa的参与者进行肝活检。结果共纳入3123名受试者；代谢组1599例，酒精组1524例。总共有2197例（70%）被诊断为SLD: 1603例（51%）被诊断为MASLD， 398例（13%）被诊断为MetALD， 196例（6.3%）被诊断为ALD。在LSM≥8kpa的307例（9.8%）患者中，169例（55%）行肝活检。在代谢组中，1237例（77%）患有SLD， 147例（9.2%）LSM≥8kpa， 24例（1.5%）活检证实为晚期肝纤维化。在酒精组中，960例（63%）患有SLD， 160例（10.5%）LSM≥8kpa， 46例（3.1%）活检证实为晚期肝纤维化。在所有亚类中，ALD表现出最高的肝脏疾病严重程度(LSM≥8 kPa: 25%；MASLD和MetALD的严重程度相当（LSM≥8kpa: 12%，活检证实的晚期纤维化：3%）。结论：在具有心脏代谢和/或酒精危险因素的个体中，70%患有SLD， 10%患有肝硬度升高，2%患有活检证实的晚期肝纤维化。影响和意义在一般人群中，脂肪变性肝病（SLD）仍未得到充分诊断。本研究提供了新的基于人群的数据，说明其在代谢和/或酒精相关风险个体中的患病率和严重程度。这些发现与临床医生、研究人员和公共卫生规划人员相关，因为患病率数据对于不断发展的筛查策略至关重要。在解释结果时应考虑方法学的局限性，包括横断面设计和有限的普遍性。

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

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.