- Metabolic Risk/Epidemiology
- Metabolic Dysfunction-Associated Steatotic Liver Disease and All-Cause and Cause-Specific Mortality
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Rosa Oh, Seohyun Kim, So Hyun Cho, Jiyoon Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim
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Diabetes Metab J. 2025;49(1):80-91. Published online August 28, 2024
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DOI: https://doi.org/10.4093/dmj.2024.0042
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 Abstract
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- Background
Given the association between nonalcoholic fatty liver disease and metabolic risks, a new term, metabolic dysfunction- associated steatotic liver disease (MASLD) has been proposed. We aimed to explore the association between MASLD and all-cause, cause-specific mortalities.
Methods
We included individuals with steatotic liver disease (SLD) from the Korean National Health Insurance Service. Moreover, SLD was defined as a fatty liver index ≥30. Furthermore, MASLD, metabolic alcohol-associated liver disease (MetALD), and alcoholic liver disease (ALD) with metabolic dysfunction (MD) were categorized based on alcohol consumption and MD. We also analyzed all-cause, liver-, cancer-, hepatocellular carcinoma (HCC)- and cardiovascular (CV)-related mortalities.
Results
This retrospective nationwide cohort study included 1,298,993 individuals aged 40 to 79 years for a mean follow-up duration of 9.04 years. The prevalence of MASLD, MetALD, and ALD with MD was 33.11%, 3.93%, and 1.00%, respectively. Relative to the “no SLD” group, multivariable analysis identified that MASLD (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.26 to 1.31), MetALD (aHR, 1.38; 95% CI, 1.32 to 1.44), and ALD with MD group (aHR, 1.80; 95% CI, 1.68 to 1.93) have a significantly higher risk of all-cause mortality. Furthermore, MASLD, MetALD, ALD with MD groups showed higher liver-, cancer-, and HCC-related mortality than “no SLD” group. While all-cause specific mortalities increase from MASLD to MetALD to ALD with MD, the MetALD group shows a lower risk of CV-related mortality compared to MASLD. However, ALD with MD group still have a higher risk of CV-related mortality compared to MASLD.
Conclusion
SLD is associated with an increased risk of all-cause, liver-, cancer-, HCC-, and CV-related mortalities.
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Citations
Citations to this article as recorded by  - KASL clinical practice guidelines for the management of metabolic dysfunction-associated steatotic liver disease 2025
Won Sohn, Young-Sun Lee, Soon Sun Kim, Jung Hee Kim, Young-Joo Jin, Gi-Ae Kim, Pil Soo Sung, Jeong-Ju Yoo, Young Chang, Eun Joo Lee, Hye Won Lee, Miyoung Choi, Su Jong Yu, Young Kul Jung, Byoung Kuk Jang
Clinical and Molecular Hepatology.2025; 31(Suppl): S1. CrossRef - Diagnosis and Management of Early Stages of ALD
Jordi Gratacós-Ginès, Edilmar Alvarado-Tapias, David Martí-Aguado, Hugo López-Pelayo, Ramón Bataller, Elisa Pose
Seminars in Liver Disease.2025;[Epub] CrossRef - Refining Risk Estimates of Colorectal Cancer in Steatotic Liver Disease: Insights on Methodological Challenges
Wei-Chun Cheng, Ching-Nung Wu, Pin-Nan Cheng
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef - High-Sensitivity C-Reactive Protein Levels in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), Metabolic Alcohol-Associated Liver Disease (MetALD), and Alcoholic Liver Disease (ALD) with Metabolic Dysfunction
Seong-Uk Baek, Jin-Ha Yoon
Biomolecules.2024; 14(11): 1468. CrossRef
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