Ciardullo Stefano, Carbone Marco, Invernizzi Pietro, Perseghin Gianluca
Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
Liver Int. 2023 Nov;43(11):2425-2433. doi: 10.1111/liv.15695. Epub 2023 Aug 17.
The aim of the present study is to explore the epidemiologic impact of the definition of steatotic liver disease (SLD) proposed by a multi-society (American Association for the Study of the Liver-the European Association for the Study of Liver Diseases-Asociación Latinoamericana para el Estudio del Hígado) Delphi consensus statement.
This is a cross-sectional study of US adults participating in the 2017-2020 cycles of the National Health and Nutrition Examination Survey who were evaluated by vibration-controlled transient elastography. Hepatic steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter and liver stiffness measurement using cut-offs of 274 dB/m and 8.0 kPa, respectively. Recently proposed criteria for metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD + significant alcohol consumption), MASLD-Viral hepatitis and cryptogenic SLD were applied.
SLD was present in 42.1% (95% CI: 40.3-43.9) of the 3173 included participants. Among patients with SLD, 99.4% met the metabolic dysfunction definition. Moreover, 89.4%, 7.7%, 2.4%, 0.4% and 0.1% were defined as MASLD, MetALD, MASLD-Viral, alcoholic liver disease (ALD) (significant alcohol consumption without metabolic dysfunction) and cryptogenic, respectively. No patients without metabolic dysfunction had significant liver fibrosis, which was present in 15.2%, 9.5% and 19.5% of patients with MASLD, MetALD and MASLD-viral, respectively. Approximately, 90% of the overall adult US population could be diagnosed with metabolic dysfunction according to the consensus criteria. A high degree of concordance was found between MASLD and the previously proposed metabolic dysfunction-associated fatty liver disease definition.
Metabolic dysfunction is present in almost all patients with SLD in the United States. The new change in diagnostic criteria did not significantly impact disease prevalence.
本研究旨在探讨多学会（美国肝脏研究协会-欧洲肝脏研究协会-拉丁美洲肝脏研究协会）德尔菲共识声明提出的脂肪性肝病（SLD）定义的流行病学影响。
这是一项对参与2017 - 2020年国家健康与营养检查调查周期的美国成年人进行的横断面研究，这些成年人通过振动控制瞬时弹性成像进行评估。分别使用274 dB/m和8.0 kPa的截断值，通过控制衰减参数的中位数和肝脏硬度测量来诊断肝脂肪变性和肝纤维化。应用了最近提出的代谢功能障碍相关脂肪性肝病（MASLD）、MetALD（MASLD + 大量饮酒）、MASLD - 病毒性肝炎和隐源性SLD的标准。
在纳入的3173名参与者中，42.1%（95%置信区间：40.3 - 43.9）存在SLD。在SLD患者中，99.4%符合代谢功能障碍定义。此外，分别有89.4%、7.7%、2.4%、0.4%和0.1%被定义为MASLD、MetALD、MASLD - 病毒性、酒精性肝病（ALD）（大量饮酒但无代谢功能障碍）和隐源性。没有代谢功能障碍的患者均无显著肝纤维化，而在MASLD、MetALD和MASLD - 病毒性患者中，肝纤维化的发生率分别为15.2%、9.5%和19.5%。根据共识标准，美国成年人群中约90%可被诊断为代谢功能障碍。MASLD与先前提出的代谢功能障碍相关脂肪性肝病定义之间存在高度一致性。
在美国，几乎所有SLD患者都存在代谢功能障碍。诊断标准的新变化对疾病患病率没有显著影响。
