Park Jeayeon, Chung Goh Eun, Yu Su Jong, Kim Yoon Jun, Yoon Jung-Hwan, Han Kyungdo, Cho Eun Ju
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
JHEP Rep. 2025 Jun 7;7(9):101477. doi: 10.1016/j.jhepr.2025.101477. eCollection 2025 Sep.
BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major cause of chronic liver disease globally, particularly among young adults. We aimed to analyze all-cause and disease-specific mortality in young adults with MASLD. METHODS: In this nationwide cohort study, we analyzed data from the Korean National Health Insurance Service, focusing on individuals aged 20 to 39 years who underwent health screenings between 2009 and 2012. The participants were categorized into two groups: those with MASLD and those without steatotic liver disease (SLD). SLD was defined by a fatty liver index ≥30. Mortality risk was analyzed via Cox proportional hazards models. RESULTS: A total of 5,699,047 participants were included in the study, 25.4% of whom had MASLD. During a median follow-up of 10.6 years (interquartile range, 9.5-11.2), all-cause death occurred in 11,706 (0.8%) participants in the MASLD group and in 19,611 (0.5%) in the non-SLD group. Young adults with MASLD had a significantly greater risk of all-cause mortality than those without steatosis (adjusted hazard ratio [aHR], 1.15; 95% CI 1.12-1.19). The MASLD group also had an increased risk of mortality related to cardiovascular disease, liver cancer, and liver disease, whereas the risk of extrahepatic cancer-related mortality did not significantly differ between the two groups. Compared to men with MASLD, women with MASLD had higher risks of all-cause, cardiovascular, extrahepatic cancer, and liver disease-related mortality, although the risk of liver cancer-related mortality was similar between the sexes. CONCLUSION: Young adults with MASLD are at a significantly increased risk of all-cause and disease-specific mortality. These findings underscore the importance of early detection and intervention to mitigate the long-term outcomes of MASLD in young adults. IMPACT AND IMPLICATIONS: Global increases in obesity among adolescents and young adults are driving an increase in the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in these populations. In this nationwide cohort study, young adults with MASLD were found to have a significantly greater risk of all-cause mortality, as well as mortality related to cardiovascular disease, liver cancer, and liver disease than those without steatosis. Therefore, early detection and timely intervention for MASLD in young adults are crucial to improving clinical outcomes and reducing the global burden of the disease.
背景与目的：代谢功能障碍相关脂肪性肝病（MASLD）已成为全球慢性肝病的主要病因，在年轻人中尤为常见。我们旨在分析患有MASLD的年轻人的全因死亡率和疾病特异性死亡率。 方法：在这项全国性队列研究中，我们分析了韩国国民健康保险服务的数据，重点关注2009年至2012年间接受健康筛查的20至39岁个体。参与者被分为两组：患有MASLD的人和没有脂肪性肝病（SLD）的人。SLD由脂肪肝指数≥30定义。通过Cox比例风险模型分析死亡风险。 结果：共有5,699,047名参与者纳入研究，其中25.4%患有MASLD。在中位随访10.6年（四分位间距，9.5 - 11.2）期间，MASLD组有11,706名（0.8%）参与者全因死亡，非SLD组有19,611名（0.5%）。患有MASLD的年轻人全因死亡风险显著高于无脂肪变性者（调整后风险比[aHR]，1.15；95%置信区间1.12 - 1.19）。MASLD组心血管疾病、肝癌和肝病相关死亡率也增加，而两组肝外癌症相关死亡率风险无显著差异。与患有MASLD的男性相比，患有MASLD的女性全因、心血管、肝外癌症和肝病相关死亡率风险更高，尽管两性肝癌相关死亡率风险相似。 结论：患有MASLD的年轻人全因和疾病特异性死亡风险显著增加。这些发现强调了早期检测和干预对于减轻年轻人MASLD长期后果的重要性。 影响与启示：全球青少年和年轻人肥胖率上升导致这些人群中代谢功能障碍相关脂肪性肝病（MASLD）患病率增加。在这项全国性队列研究中，发现患有MASLD的年轻人全因死亡率以及心血管疾病、肝癌和肝病相关死亡率显著高于无脂肪变性者。因此，对年轻人MASLD进行早期检测和及时干预对于改善临床结局和减轻全球疾病负担至关重要。
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