University of California at San Diego, La Jolla, California, USA.
Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
Gut. 2024 Nov 11;73(12):2045-2053. doi: 10.1136/gutjnl-2024-332917.
There are limited prospective data among overweight and obese individuals on the prevalence of advanced fibrosis, and cirrhosis using advanced MRI-based methods in the USA. The aim of this study was to fill that gap in knowledge by prospectively determining the MRI-based prevalence of steatotic liver disease (SLD) and its subcategories, advanced fibrosis and cirrhosis among overweight and obese individuals residing in the USA.
This is a cross-sectional analysis of prospectively enrolled overweight or obese adults aged 40-75 years from primary care and community-based settings in Southern California. Participants were classified as having SLD if MRI proton density fat fraction ≥5%, and subclassified as metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD) and alcohol-related liver disease (ALD) consistently with the new nomenclature guidance per AASLD-EASL-ALEH. Advanced fibrosis and cirrhosis were defined as magnetic resonance elastography (MRE) ≥3.63 kPa and MRE ≥4.67 kPa, respectively.
The cohort included 539 participants with mean (±SD) age of 51.5 (±13.1) years and body mass index of 32.6 (±6.2) kg/m, respectively. The prevalence of SLD, advanced fibrosis and cirrhosis was 75%, 10.8% and 4.5%, respectively. The prevalence of MASLD, MetALD and ALD was 67.3%, 4.8% and 2.6%, respectively. There was no difference in prevalence of advanced fibrosis and cirrhosis among subcategories.
Using advanced MRI methods among community-dwelling overweight and obese adults, the prevalence of cirrhosis was 4.5%. Most common SLD subcategory was MASLD with 67% of individuals, whereas MetALD and ALD were less common. Systematic screening for advanced fibrosis among overweight/obese adults may be considered.
在美国，超重和肥胖人群中使用先进的 MRI 方法评估晚期纤维化和肝硬化的患病率的前瞻性数据有限。本研究旨在通过前瞻性确定超重和肥胖人群中脂肪性肝病（SLD）及其亚类（包括晚期纤维化和肝硬化）的 MRI 患病率，填补这一知识空白。
这是一项横断面分析，纳入了南加州初级保健和社区环境中 40-75 岁的超重或肥胖成年人。如果 MRI 质子密度脂肪分数≥5%，则将参与者归类为 SLD；如果符合新的命名学指南（根据 AASLD-EASL-ALEH）归类为代谢功能障碍相关脂肪性肝病（MASLD）、代谢功能障碍和酒精相关肝病（MetALD）和酒精相关肝病（ALD），则将其归为亚类。晚期纤维化和肝硬化分别定义为磁共振弹性成像（MRE）≥3.63kPa 和 MRE≥4.67kPa。
该队列包括 539 名参与者，平均（±SD）年龄为 51.5（±13.1）岁，体重指数为 32.6（±6.2）kg/m²。SLD、晚期纤维化和肝硬化的患病率分别为 75%、10.8%和 4.5%。MASLD、MetALD 和 ALD 的患病率分别为 67.3%、4.8%和 2.6%。各亚类的晚期纤维化和肝硬化患病率无差异。
在社区居住的超重和肥胖成年人中使用先进的 MRI 方法，肝硬化的患病率为 4.5%。最常见的 SLD 亚类是 MASLD，占 67%，而 MetALD 和 ALD 则较少见。可能需要考虑对超重/肥胖成年人进行晚期纤维化的系统筛查。
