Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
Metabolism. 2024 Mar;152:155789. doi: 10.1016/j.metabol.2024.155789. Epub 2024 Jan 13.
A new fatty liver disease nomenclature, steatotic liver disease (SLD) has been proposed; however, there are no data on clinical outcomes. We investigated the impact of SLD with metabolic dysfunction (MD; SLD-MD) on all-cause mortality.
We evaluated nationally representative participants aged ≥19 years using data from the Korea National Health and Nutrition Examination Survey 2007-2015 and their linked death data through 2019. The presence of fatty liver disease was assessed by liver fat score, fatty liver index and significant liver fibrosis was evaluated by the Fibrosis-4 Index, and fibrosis score. SLD-MD was categorized into three groups: metabolic dysfunction-associated steatotic liver disease (MASLD); metabolic alcoholic liver disease (MetALD); and SLD with other combination etiologies.
Among 26734 individuals (11561 men and 15173 women, mean age 48.8 years), 1833 (6.9 %) died during a mean follow-up period of 110.6 ± 33.9 months. Mortality risk was significantly higher in individuals with SLD-MD (hazard ratio [HR] = 1.35) than in those without (P < 0.001). Among the three groups, MASLD (HR = 1.32) and SLD with other combination etiologies (HR = 2.06) independently increased mortality risk (all P < 0.001). When individuals with SLD-MD had significant liver fibrosis or diabetes, mortality risk increased further (HR = 1.68 and 1.85, respectively; all P < 0.001). SLD-MD with both significant liver fibrosis and diabetes showed the highest mortality risk (HR = 2.29, P < 0.001). When applied fatty liver index and fibrosis score, similar results were observed.
SLD-MD is associated with a higher mortality risk. When SLD-MD was combined with significant liver fibrosis or diabetes, the mortality risk became much higher. Treatment strategies to reduce fibrotic burden and improve glycemic control in individuals with MASLD are needed.
新的脂肪肝疾病命名法，脂肪性肝病（SLD）已经提出;然而，目前还没有关于临床结果的数据。我们研究了代谢功能障碍（MD；SLD-MD）对全因死亡率的影响。
我们使用 2007-2015 年韩国国家健康和营养检查调查的数据以及通过 2019 年链接的死亡数据，评估了年龄≥19 岁的具有全国代表性的参与者。通过肝脂肪评分、脂肪肝指数评估脂肪肝疾病的存在，通过纤维化 4 指数和纤维化评分评估显著的肝纤维化。将 SLD-MD 分为三组：代谢相关脂肪性肝病（MASLD）；代谢性酒精性肝病（MetALD）；以及其他合并病因的 SLD。
在 26734 名参与者（男性 11561 名，女性 15173 名，平均年龄 48.8 岁）中，1833 名（6.9%）在平均 110.6±33.9 个月的随访期间死亡。与无 SLD-MD 的个体相比，有 SLD-MD 的个体的死亡风险明显更高（危险比[HR]1.35，P<0.001）。在这三组中，MASLD（HR1.32）和其他病因的 SLD（HR2.06）独立增加了死亡率风险（均 P<0.001）。当 SLD-MD 患者有显著的肝纤维化或糖尿病时，死亡率风险进一步增加（HR1.68 和 1.85，均 P<0.001）。同时具有显著肝纤维化和糖尿病的 SLD-MD 显示出最高的死亡率风险（HR2.29，P<0.001）。当应用脂肪肝指数和纤维化评分时，观察到类似的结果。
SLD-MD 与更高的死亡率风险相关。当 SLD-MD 与显著的肝纤维化或糖尿病合并时，死亡率风险会更高。需要针对 MASLD 患者制定减少纤维化负担和改善血糖控制的治疗策略。
