Prevalence, proportions of elevated liver enzyme levels, and long-term cardiometabolic mortality of patients with metabolic dysfunction-associated steatotic liver disease

Yi-Ting Chen; Tzu-I Chen; Szu-Ching Yin; Chia-Wei Huang; Jee-Fu Huang; Sheng-Nan Lu; Ming-Lun Yeh; Chung-Feng Huang; Chia-Yen Dai; Yu-Wei Chen; Wan-Long Chuang; Ming-Lung Yu; Mei-Hsuan Lee

doi:10.1111/jgh.16592

Prevalence, proportions of elevated liver enzyme levels, and long-term cardiometabolic mortality of patients with metabolic dysfunction-associated steatotic liver disease

J Gastroenterol Hepatol. 2024 May 9. doi: 10.1111/jgh.16592. Online ahead of print.

Authors

Yi-Ting Chen¹, Tzu-I Chen¹, Szu-Ching Yin¹, Chia-Wei Huang^{1

2}, Jee-Fu Huang^{3

4

5}, Sheng-Nan Lu⁶, Ming-Lun Yeh^{3

4

5}, Chung-Feng Huang^{3

4

5}, Chia-Yen Dai^{3

4

5}, Yu-Wei Chen^{1

7

8

9}, Wan-Long Chuang^{3

4

5}, Ming-Lung Yu^{3

6

10

11

12}, Mei-Hsuan Lee^{1

2

12

13}

Affiliations

¹ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Advanced Therapeutics Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
⁷ Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
⁸ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁹ Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
¹⁰ School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹¹ School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹² Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹³ Master of Public Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan.

PMID: 38725327
DOI: 10.1111/jgh.16592

Abstract

Background and aim: This study estimated the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) according to cardiometabolic risk factors. The long-term impacts of MASLD on all-cause and cardiometabolic-specific mortality were evaluated.

Methods: We enrolled 343 816 adults aged ≥30 years who participated in a health screening program from 1997 through 2013. MASLD was identified on the basis of abdominal ultrasonography and metabolic profiles. The participants were further categorized by liver enzyme elevation. Baseline cardiometabolic comorbidities were classified on the basis of self-reported medication use and clinical seromarkers. All-cause and cardiometabolic-specific deaths were determined through computerized data linkage with nationwide death certifications until December 31, 2020.

Results: The overall prevalence of MASLD was 36.4%. Among patients with MASLD, 35.9% had abnormal liver enzyme levels. Compared with patients without MASLD, abnormal liver enzymes were positively associated with cardiometabolic comorbidities in patients with MASLD (P_{for trend} < 0.001). After follow-up, patients with MASLD had a 9%-29% higher risk of all-cause, cardiovascular-related, or diabetes-related mortality. In the groups with MASLD and elevated and normal liver enzyme levels, the multivariate-adjusted hazard ratios for cardiovascular deaths were 1.14 (1.05-1.25) and 1.10 (1.03-1.17), respectively, and those for diabetes deaths were 1.42 (1.05-1.93) and 1.24 (0.98-1.57), respectively, compared with those in the non-MASLD group (P_{for trend} < 0.001).

Discussion: Individuals with MASLD and elevated liver enzyme levels exhibited significantly higher risks of all-cause and cardiometabolic deaths and should be monitored and given consultation on cardiometabolic modifications.

Keywords: long‐term risk; nonalcoholic fatty liver disease; noncommunicable diseases.

Abstract

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