Niezen Sebastian, Morgan Timothy R, Scott Dawn, Yakovchenko Vera, Patton Heather, Spoutz Patrick, Yao Yiwen, Baffy Gyorgy, Fuchs Michael, Bajaj Jasmohan S, Ekanem Nsikak R, Dominitz Jason A, Rogal Shari S
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Am J Gastroenterol. 2025 Jan 7. doi: 10.14309/ajg.0000000000003312.
Metabolic dysfunction-associated steatotic liver disease (MASLD), an increasing public health concern, remains challenging to diagnose and risk-stratify. We assessed the (i) prevalence of MASLD risk factors among veterans in Veterans Health Administration (VA) care, (ii) factors associated with MASLD diagnosis, and (iii) associations between MASLD diagnosis and receipt of care.
Veterans with MASLD risk factors, including obesity, prediabetes, diabetes, or dyslipidemia, were identified using International Classification of Diseases-10 codes and followed in 2019-2022. Multivariable logistic regression and propensity score-adjusted models identified demographic and clinical characteristics associated with a diagnosis of MASLD or cirrhosis and receipt of elastography, specialty care for liver disease, VA weight management (MOVE!) participation, and glucagon-like peptide-1 (GLP-1) analog prescriptions.
Among approximately 9 million veterans, 4,159,699 (45%) had risk factors for MASLD and were included in further analysis. MASLD or cirrhosis was diagnosed in 6% of the at-risk cohort. At-risk Veterans diagnosed with MASLD were younger with more metabolic risk factors, increased rates of alcohol use disorder, and higher FIB-4 scores and alanine transaminase values. Over 1-year follow-up, 6% engaged in MOVE!, 9% had specialty care for liver disease, 3% were prescribed GLP-1 analogs, and 2% underwent staging elastography. MASLD diagnosis was significantly associated with receipt of MOVE!, specialty care consultation, and GLP-1 analog prescription.
Few at-risk Veterans carried an MASLD diagnosis or had undergone staging elastography. Because MASLD diagnosis was associated with linkage to hepatology care and weight loss therapy services, implementation of population screening and management services for MASLD is critically needed.
代谢功能障碍相关脂肪性肝病（MASLD）是一个日益受到关注的公共卫生问题，其诊断和风险分层仍然具有挑战性。我们评估了（i）退伍军人健康管理局（VA）护理中退伍军人MASLD风险因素的患病率，（ii）与MASLD诊断相关的因素，以及（iii）MASLD诊断与接受护理之间的关联。
使用国际疾病分类第10版代码识别患有MASLD风险因素（包括肥胖、糖尿病前期、糖尿病或血脂异常）的退伍军人，并在2019 - 2022年进行随访。多变量逻辑回归和倾向评分调整模型确定了与MASLD或肝硬化诊断以及接受弹性成像、肝病专科护理、VA体重管理（MOVE！）参与和胰高血糖素样肽 - 1（GLP - 1）类似物处方相关的人口统计学和临床特征。
在约900万退伍军人中，4,159,699人（45%）有MASLD风险因素并纳入进一步分析。在有风险的队列中，6%被诊断为MASLD或肝硬化。被诊断为MASLD的有风险退伍军人更年轻，有更多代谢风险因素，酒精使用障碍发生率更高，FIB - 4评分和丙氨酸转氨酶值更高。在1年的随访中，6%参与了MOVE！，9%接受了肝病专科护理，3%被开具GLP - 1类似物处方，2%接受了分期弹性成像检查。MASLD诊断与接受MOVE！、专科护理咨询和GLP - 1类似物处方显著相关。
很少有有风险的退伍军人被诊断为MASLD或接受分期弹性成像检查。由于MASLD诊断与肝病护理和体重减轻治疗服务相关，因此迫切需要实施针对MASLD的人群筛查和管理服务。
