Clinical Characteristics of Steatotic Liver Disease Categories in a Large Cohort of Japanese Health Checkup Participants

Abstract

Background and aims: The clinical characteristics and risk factors involved in the development of liver fibrosis in the subtypes of steatotic liver disease (SLD) remain unknown. We examined the clinical characteristics of SLD subtypes using a large Japanese cohort.

Methods: We performed a cross-sectional analysis (total n = 108,446). In this cohort, SLD was diagnosed by ultrasonography. Individuals with none of the cardiometabolic risk factors were excluded.

Results: According to their nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) status based on the database, participants with cardiometabolic criteria were allocated to the MASLD, MASLD with increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD) with metabolic dysfunction groups. Of 30,857 subjects with SLD, 21,488 (69.6%) had NAFLD, and 20,922 (67.8%) had MASLD. There were few differences in the clinical characteristics between NAFLD and MASLD. After adjustment for clinical variables, we found that male patients with MetALD [odds ratio (OR) 2.26; 95% confidence interval (CI) 1.87-2.84] and ALD with metabolic dysfunction (OR 3.92; 95% CI 2.85-5.39) had a significantly higher risk for advanced liver fibrosis (diagnosed by Fibrosis-4 (FIB-4) index >2.67) compared to those with MASLD. In female patients with ALD, metabolic dysfunction (OR 5.80; 95% CI 2.51-13.4) and systemic blood pressure of ≥130 mmHg were significant risk factors for high FIB-4 (males: OR 3.38, 95% CI 2.51-4.55; females: OR 4.34, 95% CI 2.66-7.07, P < .001).

Conclusion: Alcohol intake and systolic blood pressure are independent contributors to liver fibrosis progression assessed by FIB-4 in SLD.

Keywords: Alcohol Intake; FIB-4 Index; Metabolic Dysfunction; Steatotic Liver Disease; Systolic Blood Pressure.

Figure 1

Prevalence of NAFLD and MASLD in our study cohort. Among 30,857 subjects, the number of NAFLD-only subjects was 21,488, and the number of MASLD-only subjects was 20,922. The number of overlapping subjects (ie, those with NAFLD and MASLD) was 20,763. Approximately 97% of subjects with NAFLD and 99% of subjects with MASLD were overlapping subjects in our cohort.

Figure 2

Prevalence rates of alcohol consumption in males (A) and females (B) stratified by age daily alcohol intake is illustrated by age group and sex. Dotted lines indicate the threshold values for drinkers (males >30 g/day, females >20 g/day).

Figure A1

Subject flowchart for this study.

Figure A2

Prevalence rates of smoking status (never, ever, current) among males (A) and females. The association between daily alcohol intake and smoking status is illustrated by sex. White, grey, and black columns indicate never, experienced, and current smokers, respectively.

Figure A3

Prevalence of FIB-4 index categories among males (A) and females (B) stratified by age; A, C) subjects <60 years, B, D) subjects ≥60 years. The percentages of FIB-4 scores by sex and alcohol consumption are shown. White, grey, and black columns indicate low (<1.3), intermediate (1.3–2.67), and high (>2.67) in FIB-4 scores, respectively.