TOPLINE:
Steatotic liver disease (SLD) was highly prevalent among adults with cardiometabolic risk factors, prolonged alcohol intake, or both combined and affected 70% of participants overall. Alcohol-related liver disease (ALD) showed the highest prevalence of elevated liver stiffness, affecting 25% of participants.
METHODOLOGY:
- Researchers conducted a prospective study in Denmark to identify the prevalence, fibrosis severity, and determinants of SLD in 3123 participants (median age, 57 years; 50% women) enrolled through electronic invitations between October 2017 and November 2022; 98% of them had at least one cardiometabolic risk factor.
- They categorised participants into the following two groups on the basis of the type of risk factors they had:
- Metabolic cohort: defined as having a BMI > 30 and/or type 2 diabetes without a history of prolonged high alcohol intake (n = 1599)
- Alcohol cohort: defined as having ongoing or prior prolonged high alcohol intake, as defined by an average daily intake exceeding 24 g for women and 36 g for men for more than 5 years, regardless of cardiometabolic risk factors (n = 1524).
- Liver steatosis was diagnosed using the controlled attenuation parameter, and liver fibrosis was diagnosed using liver stiffness measurements (LSMs). In participants with LSM values ≥ 8 kPa at baseline, fibrosis stage and steatosis were evaluated through liver histology.
- Three SLD subgroups were defined as those with metabolic dysfunction-associated SLD (MASLD; presence of liver steatosis, at least one cardiometabolic risk factor, and low alcohol intake), metabolic and ALD (MetALD; presence of liver steatosis, at least one cardiometabolic risk factor, and moderate alcohol intake), and ALD (high alcohol intake in those without cardiometabolic risk factors or very heavy intake regardless of the cardiometabolic risk).
TAKEAWAY:
- Overall, 70% of participants had SLD, of whom 51% had MASLD, 13% had MetALD, and 6.3% had ALD. More participants in the metabolic cohort than in the alcohol cohort had SLD.
- Participants with ALD demonstrated the highest disease severity, with 25% vs 12% of those in MASLD and MetALD groups showing LSM values ≥ 8 kPa, and 8% of participants in the ALD group vs 2.8% and 2.6% of those in MASLD and MetALD groups, respectively, had advanced fibrosis.
- All cardiometabolic risk factors increased the odds of liver steatosis, with high waist circumference emerging as the strongest risk factor (odds ratio, 6.65; 95% CI, 5.36-8.25), and two risk alleles were identified as significant genetic determinants.
- Higher levels of education and increased physical activity were associated with decreased odds of liver steatosis, and insulin resistance emerged as the most prominent risk factor for elevated liver stiffness.
IN PRACTICE:
“Social determinants of health, genetic risk, and lifestyle factors further influence the prevalence of SLD, calling for nuanced management in primary care, particularly in addressing health inequality through preventive care initiatives,” the authors of the study wrote.
SOURCE:
This study was led by Camilla Dalby Hansen, Odense University Hospital, Odense, Denmark. It was published online on July 04, 2025, in the Journal of Hepatology.
LIMITATIONS:
Electronic invitation-based recruitment likely introduced selection bias and may not represent the general population. The single-centre design and predominantly White participant population limited the generalisability to other ethnic and cultural groups. Prognostic differences among SLD subclasses could not be detected due to the lack of long-term follow-up.
DISCLOSURES:
This study received funding from the Novo Nordisk Foundation to the DECIDE project and MicrobLiver, the European Union’s Horizon 2020 to GALAXY and LiverScreen projects, University of Southern Denmark, Region of Southern Denmark, Novo Nordisk Foundation, and AstraZeneca. Some authors reported receiving speaker/consultation fees and research support and being board/advisory board members of various pharmaceutical companies. Two authors reported being co-founders of Evido.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.