Sripongpun Pimsiri, Kaewdech Apichat, Udompap Prowpanga, Kim W Ray
Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, California, USA.
JHEP Rep. 2024 Jun 3;6(10):101127. doi: 10.1016/j.jhepr.2024.101127. eCollection 2024 Oct.
BACKGROUND & AIMS: The new nomenclature of steatotic liver disease (SLD) was recently launched with sub-classifications of metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Herein, we aimed to evaluate the characteristics and long-term outcomes associated with these subgroups and the utility of non-invasive biomarkers. METHODS: Using NHANES III (the third National Health and Nutrition Examination Survey) and linked mortality data, all adult participants with available ultrasonographic liver steatosis status were included. Those with viral hepatitis, incomplete data on alcohol consumption, cardiometabolic risk, and missing data that hindered Steatosis-associated Fibrosis Estimator (SAFE) score calculation were excluded. The characteristics of those without SLD (no steatosis on ultrasound), MASLD, MetALD, and ALD were compared. Overall survival (OS) was determined and SAFE score strata were applied to SLD subgroups. RESULTS: A total of 9,939 participants were eligible; 64% had no SLD, while 30%, 2.3%, and 1% had MASLD, MetALD, and ALD, respectively. A higher proportion of men, as well as active smokers, was observed in the MetALD and ALD groups compared to the MASLD group. Diabetes was more prevalent in the MASLD group than in the MetALD and ALD groups. The ALD subgroup had significantly lower OS than the MASLD group ( = 0.004), but the MetALD did not ( = 0.165). SAFE score strata meaningfully differentiated OS of all SLD subgroups. CONCLUSIONS: MASLD accounted for the largest proportion of SLD. MetALD shared the characteristics of both MASLD and ALD. The ALD subgroup had a significantly lower OS than the MASLD subgroup but there was no difference between MetALD and MASLD. The SAFE score can be used to stratify long-term outcomes in all SLD subgroups. IMPACT AND IMPLICATIONS: "Steatotic liver disease (SLD)" is a recently introduced term covering three subgroups: MASLD (metabolic dysfunction-associated SLD), MetALD (MASLD with increased alcohol intake), and ALD (alcohol-related liver disease). We explored the characteristics and outcomes of these subgroups among the US population. We found that MASLD was far more common than MetALD and ALD, but all subgroups shared cardiometabolic risk factors. The ALD subgroup has the worst survival, pointing to the synergistic effect of alcohol and metabolic dysfunction. In addition, the SAFE (Steatosis-associated Fibrosis Estimator) score might be a useful non-invasive test to stratify long-term risk in all three SLD subgroups.
背景与目的：脂肪性肝病（SLD）的新命名法最近推出，包括代谢功能障碍相关SLD（MASLD）、酒精摄入量增加的MASLD（MetALD）和酒精性肝病（ALD）的亚分类。在此，我们旨在评估这些亚组的特征和长期预后以及非侵入性生物标志物的效用。 方法：使用美国国家健康与营养检查调查（NHANES）III及相关死亡率数据，纳入所有有可用肝脏超声脂肪变性状态的成年参与者。排除患有病毒性肝炎、酒精消费、心脏代谢风险数据不完整以及妨碍脂肪变性相关纤维化估计（SAFE）评分计算的缺失数据者。比较无SLD（超声无脂肪变性）、MASLD、MetALD和ALD者的特征。确定总生存期（OS），并将SAFE评分分层应用于SLD亚组。 结果：共有9939名参与者符合条件；64%无SLD，而分别有30%、2.3%和1%患有MASLD、MetALD和ALD。与MASLD组相比，MetALD组和ALD组男性以及当前吸烟者的比例更高。糖尿病在MASLD组比在MetALD组和ALD组更普遍。ALD亚组的OS显著低于MASLD组（P = 0.004），但MetALD组与MASLD组无差异（P = 0.165）。SAFE评分分层能够有效区分所有SLD亚组的OS。 结论：MASLD在SLD中占比最大。MetALD兼具MASLD和ALD的特征。ALD亚组的OS显著低于MASLD亚组，但MetALD组与MASLD组之间无差异。SAFE评分可用于对所有SLD亚组的长期预后进行分层。 影响与意义：“脂肪性肝病（SLD）”是最近引入的一个术语，涵盖三个亚组：MASLD（代谢功能障碍相关SLD）、MetALD（酒精摄入量增加的MASLD）和ALD（酒精性肝病）。我们在美国人群中探索了这些亚组的特征和预后。我们发现MASLD远比MetALD和ALD常见，但所有亚组都有心脏代谢风险因素。ALD亚组的生存率最差，表明酒精和代谢功能障碍具有协同作用。此外，SAFE（脂肪变性相关纤维化估计）评分可能是一种有用的非侵入性检测方法，可对所有三个SLD亚组的长期风险进行分层。
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