Natural history of lean and non-lean metabolic dysfunction-associated steatotic liver disease

• Published in: Journal of gastroenterology 2024-06, Vol.59 (6), p.494-503
• Main Authors: Wakabayashi, Shun-Ichi, Tamaki, Nobuharu, Kimura, Takefumi, Umemura, Takeji, Kurosaki, Masayuki, Izumi, Namiki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Biliary Tract; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Colorectal Surgery; Databases, Factual; Fatty Liver - epidemiology; Female; Gastroenterology; Hepatology; Humans; Incidence; Liver diseases; Male; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - epidemiology; Original Article―Liver; Pancreas; Population studies; Prognosis; Risk Factors; Surgical Oncology; Thinness - epidemiology
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-024-02093-z

Background Conflicting evidence regarding the prognosis of lean metabolic dysfunction-associated steatotic liver disease (MASLD) has raised substantial questions. Aim This study aimed to elucidate the prognosis of lean MASLD by conducting a comprehensive analysis of a vast Asian cohort. Methods This study used a nationwide, population-based database and analyzed 2.9 million patients. The primary endpoints were liver-related events (LREs) and cardiovascular events (CVEs) in patients with lean MASLD, non-lean MASLD, and normal liver control groups. Results The median observation period was 4.2 years. The 5-year incidence values of LREs in the lean MASLD, non-lean MASLD, and normal liver control groups were 0.065%, 0.039%, and 0.006%, respectively. The LRE risk of lean MASLD was significantly higher than that of normal liver control (adjusted hazard ratio [aHR]: 5.94, 95% confidence interval [CI]: 3.95–8.92) but comparable to that of non-lean MASLD (aHR: 1.35, 95% CI: 0.87–2.08). By contrast, for CVEs, the non-lean MASLD group exhibited a higher 5-year cumulative incidence rate (0.779%) than the lean MASLD (0.600%) and normal liver control (0.254%) groups. The lean MASLD group had a reduced risk of CVEs compared with the non-lean MASLD group (aHR, 0.73; 95% CI: 0.64–0.84), and comparable risk of CVEs to the normal liver control group (aHR, 0.99; 95% CI: 0.88–1.12). Conclusion Lean MASLD exhibits a similar LRE risk and a lower CVE risk to non-lean MASLD. Therefore, follow-up and treatment strategies should be tailored to the specific MASLD condition.