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. 2025 Jan;49(1):80-91.
doi: 10.4093/dmj.2024.0042. Epub 2024 Aug 28.

Metabolic Dysfunction-Associated Steatotic Liver Disease and All-Cause and Cause-Specific Mortality

Rosa Oh #  1 , Seohyun Kim #  2 , So Hyun Cho  1 , Jiyoon Kim  1 , You-Bin Lee  1 , Sang-Man Jin  1 , Kyu Yeon Hur  1 , Gyuri Kim  1 , Jae Hyeon Kim  1
Affiliations

Metabolic Dysfunction-Associated Steatotic Liver Disease and All-Cause and Cause-Specific Mortality

Rosa Oh et al. Diabetes Metab J. 2025 Jan.

Abstract

Backgruound: 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.

Keywords: Fatty liver; Metabolic syndrome; Mortality.

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Conflict of interest statement

CONFLICTS OF INTEREST

Sang-Man Jin has been associate editor of the Diabetes & Metabolism Journal since 2022. He was not involved in the review process of this article. Otherwise, there was no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart of the study. FLI, fatty liver index; MASLD, metabolic dysfunction-associated steatotic liver disease.
None
See this image and copyright information in PMC

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