Longitudinal Outcomes Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Meta-analysis of 129 Studies

Chan, Kai En; Ong, Elden Yen Hng; Chung, Charlotte Hui; Ong, Christen En Ya; Koh, Benjamin; Tan, Darren Jun Hao; Lim, Wen Hui; Yong, Jie Ning; Xiao, Jieling; Wong, Zhen Yu; Syn, Nicholas; Kaewdech, Apichat; Teng, Margaret; Wang, Jiong-Wei; Chew, Nicholas; Young, Dan Yock; Know, Alfred; Siddiqui, Mohammad Shadab; Huang, Daniel Q.; Tamaki, Nobuharu; Wong, Vincent Wai-Sun; Mantzoros, Christos S.; Sanyal, Arun; Noureddin, Mazen; Ng, Cheng Han; Muthiah, Mark

doi:10.1016/j.cgh.2023.09.018

Cited by 19 publications

(11 citation statements)

References 158 publications

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“…Our work builds on studies that have previously implicated a relationship between the two diseases and called for more work in the area to improve our understanding of potential pathophysiological mechanisms at play [ 10 , 19 ]. It further aligns with previous international work that identified a correlation between severity of fibrosis among people with MASLD and prevalence of renal impairment [ 32 – 34 ]; this effect has also been shown in people with type 1 diabetes and MASLD, where CKD prevalence can be significantly higher amongst those with fibrosis despite adjusting for renal risk factors [ 35 ]. Some particular strengths of our study are the utilisation of uACR results for a more comprehensive definition of CKD, the broader range of confounders included in adjusted analyses, and the inclusion of a survival analysis to elucidate mortality implications of people living with these co-morbidities.…”

Section: Discussionsupporting

confidence: 88%

“…To ensure appropriate care and prioritisation of clinical resources, these systems must be guided by evidence-based clinical guidelines. Currently, the American Association for the Study of Liver Disease recommends performing uACR for people with suspected MASLD, [ 58 ] and with the evidence from this study and others, [ 32 , 33 ] the addition of eGFR screening for those with fibrosis appears appropriate. Similarly, current European guidelines on the management of MASLD could consider the addition of renal screening for people with MASLD who have evidence of fibrosis [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

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Increased risk of chronic kidney disease and mortality in a cohort of people diagnosed with metabolic dysfunction associated steatotic liver disease with hepatic fibrosis

Gurun,

Brennan,

Handjiev

et al. 2024

PLoS ONE

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Background and aims Metabolic dysfunction associated steatotic liver disease (MASLD) increases the risk of incident chronic kidney disease (CKD). However, the relative risk of CKD associated with increasing hepatic fibrosis, and consequent mortality risk, remains underexplored in real-world cohorts. In this study, we sought to establish whether hepatic fibrosis is associated with increased CKD risk and explore differences in mortality risk in a cohort of people living with MASLD, contingent on liver fibrosis and CKD status. Methods This was an observational study of people who underwent routine liver function testing in Tayside, Scotland. MASLD was defined as: elevated ALT (>30 U/L) or GGT (>73 U/L); presence of diabetes, and/or hypertension, and/or obesity; weekly alcohol consumption <14 units (112g (+/-8g) alcohol); and negative screen for other aetiologies. Data was collected from digital health records. We used log-binomial models to quantify the risk of CKD among those with and without fibrosis, and Cox regression models to estimate differences in mortality risk dependent on fibrosis and CKD. Results In our cohort (n = 2,046), 1,448 (70.8%) people had MASLD without fibrosis and 598 (29.2%) with fibrosis; 161 (11.1%) and 117 (19.6%) respectively also had CKD. After excluding individuals with structural, autoimmune, or malignant CKD (n = 22), liver fibrosis (n = 593; 18.9% with CKD) was associated with increased CKD risk (aRR = 1.31, 1.04–1.64, p = 0.021). Increased mortality risk was observed for those with liver fibrosis (aHR = 2.30, 1.49–3.56, p = <0.001) and was higher again among people with both fibrosis and CKD (aHR = 5.07, 3.07–8.39, p = <0.014). Conclusions Liver fibrosis was an independent risk factor for CKD in this cohort of people living with MASLD. Furthermore, those with MASLD with liver fibrosis had higher risk for mortality and this risk was further elevated among those with co-morbid CKD. Given the increased risk of CKD, and consequent mortality risk, among people living with MASLD fibrosis, renal function screening should be considered within liver health surveillance programmes and guidelines.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Increased risk of chronic kidney disease and mortality in a cohort of people diagnosed with metabolic dysfunction associated steatotic liver disease with hepatic fibrosis

Gurun,

Brennan,

Handjiev

et al. 2024

PLoS ONE

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“…Apart from liver-related events, MASLD is also associated with increased all-cause mortality, mainly due to non-hepatic comorbidities and their complications[ 36 ], with cardiovascular events being the most common cause of death in MASLD[ 37 ]. In this context, MASLD has been related to a significantly higher risk than non-MASLD patients for occurrence of cardiovascular disease, chronic kidney disease and all types of cancer, according to recent reports[ 38 - 40 ]. Furthermore, accumulating evidence suggests a strong and independent association between MASLD and an increased risk of functional, structural and arrhythmic cardiac complications that promote the development of heart failure[ 37 , 41 ].…”

Section: Metabolism Dysfunction-associated Steatotic Liver Diseasementioning

confidence: 99%

Liver disease in patients with transfusion-dependent β-thalassemia: The emerging role of metabolism dysfunction-associated steatotic liver disease

Fragkou,

Vlachaki,

Goulis

et al. 2024

World J Hepatol

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In this Editorial, we highlight the possible role that metabolism dysfunction-associated steatotic liver disease (MASLD) may play in the future, regarding liver disease in patients with transfusion-dependent β-thalassemia (TDBT). MASLD is characterized by excessive accumulation of fat in the liver (hepatic steatosis), in the presence of cardiometabolic factors. There is a strong correlation between the occurrence of MASLD and insulin resistance, while its increased prevalence parallels the global epidemic of diabetes mellitus (DM) and obesity. Patients with TDBT need regular transfusions for life to ensure their survival. Through these transfusions, a large amount of iron is accumulated, which causes saturation of transferrin and leads to the circulation of free iron molecules, which cause damage to vital organs (primarily the liver and myocardium). Over the past, the main mechanisms for the development of liver disease in these patients have been the toxic effect of iron on the liver and chronic hepatitis C, for which modern and effective treatments have been found, resulting in successful treatment. Additional advances in the treatment and monitoring of these patients have led to a reduction in deaths, and an increase in their life expectancy. This increased survival makes them vulnerable to the onset of diseases, which until recently were mainly related to the non-thalassemic general population, such as obesity and DM. There is insufficient data in the literature regarding the prevalence of MASLD in this population or on the risk factors for its occurrence. However, it was recently shown by a study of 45 heavily transfused patients with beta-thalassemia (Padeniya et al , BJH), that the presence of steatosis is a factor influencing the value of liver elastography and thus liver fibrosis. These findings suggest that future research in the field of liver disease in patients with TDBT should be focused on the occurrence, the risk factors, and the effect of MASLD on these patients.

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“…Chavdar S. Pavlov 1 , Daria A. Teplyuk 1 , Leonid B. Lazebnik 2 , Aleksandr S. Ametov 3 , Evgeniia Yu. Pashkova 3,4 , Sergey M. Sorokoletov 4,5 , Yury P. Uspenskiy 6 , Svetlana V. Turkina 7 , Elizaveta V. Ponomarenko 8 , Aleksandr S. Maslakov 8 95% ДИ 1,22-2,35; p<0,01), МС (ОР 2,57, 95% ДИ 1,13-5,85; p=0,02), хронического заболевания почек (ОР 1,38, 95% ДИ 1,27-1,50; p<0,01), а также всех видов онкологии (ОР 1,54, 95% ДИ 1,35-1,76; p<0,01) [9]. Ожирение и MASLD признаны факторами риска гепатоцеллюлярной карциномы, и результаты недавно опубликованных метаанализов показали связь между MASLD и внутрипеченочной холангиокарциномой [10].…”

Section: The Clinician's View On the Advantages And Contradictions Of...unclassified

The clinician's view on the advantages and contradictions of the new nomenclature of steatotic liver disease: A review

Pavlov,

Teplyuk,

Lazebnik

et al. 2024

Terapevticheskii arkhiv

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In September 2023, the European Association for the Study of the Liver (EASL) updated the disease nomenclature for non-alcoholic (metabolically associated) fatty liver disease. The goals of the revision were to increase awareness among health care professionals, civil society and patients about the disease, its course, treatment and outcomes; combating stigma; focusing on the initial etiological factor, including the main (cardiometabolic) risk of disease progression; improved diagnosis based on disease biomarkers; positive impact on the potency to search for new drugs; the ability to provide personalized medical care. The terms “non-alcoholic” and “fatty” were considered stigmatizing, and therefore, it was proposed to use the term steatotic liver disease (SLD) as the name of this nosology. The terms non-alcoholic fatty liver disease (NAFLD) or metabolic associated fatty liver disease (MAFLD) have been replaced by the term metabolic dysfunction-associated steatotic liver disease (MASLD). In the case of being combined with an alcohol factor, a diagnosis in which metabolic dysfunction is combined with alcoholic liver disease is referred to as MetALD. The fundamental principle in the diagnosis of MASLD is the presence of at least one of the cardiometabolic risk factors. Alcohol consumption interacts with cardiometabolic risk factors and increases the risk of SLD decompensation. The term nonalcoholic steatohepatitis (NASH), according to the new nomenclature, has been replaced by the term metabolic dysfunction-associated steatohepatitis (MASH). The adoption of the new nomenclature should help to increase awareness about the disease, its course and outcomes, as well as improve the quality of diagnosis and treatment.

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Longitudinal Outcomes Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Meta-analysis of 129 Studies

Cited by 19 publications

References 158 publications

Increased risk of chronic kidney disease and mortality in a cohort of people diagnosed with metabolic dysfunction associated steatotic liver disease with hepatic fibrosis

Increased risk of chronic kidney disease and mortality in a cohort of people diagnosed with metabolic dysfunction associated steatotic liver disease with hepatic fibrosis

Liver disease in patients with transfusion-dependent β-thalassemia: The emerging role of metabolism dysfunction-associated steatotic liver disease

The clinician's view on the advantages and contradictions of the new nomenclature of steatotic liver disease: A review

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