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. 2025 Dec;83(6):1278-1291.
doi: 10.1016/j.jhep.2025.06.020. Epub 2025 Jul 5.

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

Camilla Dalby Hansen  1 , Johanne Kragh Hansen  1 , Mads Israelsen  2 , Peter Andersen  2 , Laura Maarit Pikkupeura  3 , Katrine Prier Lindvig  2 , Sara Elizabeth Stinson  3 , Helle Lindholm Schnefeld  2 , Julie Tellerup  2 , Maria Fogt  2 , Nikolaj Torp  1 , Maria Kjærgaard  2 , Katrine Tholstrup Bech  2 , Katrine Holtz Thorhauge  1 , Stine Johansen  1 , Ida Spedtsberg  1 , Emil Deluran  1 , Ida Falk Villesen  2 , Sönke Detlefsen  4 , Torben Hansen  3 , Aleksander Krag  5 , Maja Thiele  1
Affiliations
Free article

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

Camilla Dalby Hansen et al. J Hepatol. 2025 Dec.
Free article

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. We aimed to investigate the prevalence and severity of SLD and its subclasses: metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic- and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) in at-risk individuals.

Methods: Between Oct 2017 and Nov 2022, citizens aged 30-75 years were recruited 1:1 into: a) the metabolic cohort, comprising individuals with BMI >30 kg/m2 and/or type 2 diabetes without prolonged increased alcohol consumption; or b) the alcohol cohort, comprising individuals 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 the 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.

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.

Clinicaltrials: GOV: NCT03308916.

Keywords: Advanced liver fibrosis; Alcohol consumption; Alcohol-related liver disease (ALD); Cardiometabolic risk; Controlled attenuation parameter (CAP); Liver fibrosis; Liver stiffness measurements (LSM); Metabolic and alcohol-related liver disease (MetALD); Metabolic dysfunction-associated steatotic liver disease (MASLD); Population-based cohort; Prevalence and severity; Steatotic liver disease (SLD).

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Conflict of interest statement

Conflict of interest MI, PA, LMP, SES, HLS, JT, MF, NT, KTB, KT, SJ and SD have no conflict of interest. CDH: speakers fee from Novo Nordisk. JKH: speakers fee from Norgine. MK received a speakers fee from Siemens Healthcare. MT: consultancy fee from Novo Nordisk, GSK, Boehringer Ingelheim, AstraZeneca; speakers fee from Echosens, Siemens Healthcare, Norgine, Takeda, Madrigal, Tillotts Pharma. Board member and co-founder of Evido. Board member in Alcohol & Society (non-governmental organization). AK has served as speaker for Novo Nordisk, Norgine and Siemens and participated in advisory boards for Siemens, Boehringer Ingelheim and Novo Nordisk, all outside the submitted work. Research support; Norgine, Siemens, Nordic Bioscience, Echosens. Board member and co-founder Evido. Please refer to the accompanying ICMJE disclosure forms for further details.

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