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Liver Cancer. 2024;13(4):426-437.

Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatotic Liver Disease with Increased Alcohol Intake Increase the Risk of Developing Hepatocellular Carcinoma and Incident or Decompensated Cirrhosis: A Korean Nationwide Study.

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제1저자 김기애, 정석송 · 교신저자 김원, 한승봉, 김승업

PMID 39114758 PMC11305668 DOI 10.1159/000535943 IF 10.5 소화기내과
소속 (4)
  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
  2. Department of Medical Informatics, College of Medicine, Korea University, Seoul, Republic of Korea.
  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
  4. Divisions of Gastroenterology and Hepatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.

Abstract

INTRODUCTION This study aimed to investigate the liver-related outcomes of newly suggested metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake (MetALD), as well as alcohol-associated liver disease (ALD).

METHODS From a National Health Insurance Service Health Screening Cohort, we included 369,094 participants who underwent health checkups between 2009 and 2010 in South Korea. Steatotic liver disease (SLD) was defined as a fatty liver index ≥60. The risk of primary liver cancer (PLCa), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), incident cirrhosis, and decompensated cirrhosis was compared with no SLD. The subdistribution hazard ratio (SHR) was calculated using the Fine-Gray model regarding competing risks.

RESULTS A total of 3,232 participants (0.9%) developed PLCa during the median follow-up of 3,227,176 person-years: 0.5% with no SLD, 1.1% with MASLD, 1.3% with MetALD, and 1.9% with ALD. Competing risk analysis revealed that compared with no SLD, MASLD (SHR: 1.65; 95% CI: 1.44-1.88), MetALD (SHR: 1.87; 95% CI: 1.52-2.29), and ALD (SHR: 1.86; 95% CI: 1.39-2.49) were associated with an increased risk of PLCa. MASLD (SHR: 1.96; 95% CI: 1.67-2.31), MetALD (SHR: 2.23; 95% CI: 1.75-2.84), and ALD (SHR: 2.34; 95% CI: 1.67-3.29) were associated with a higher risk of HCC. No significant difference was observed in the risk of iCCA. The risk of incident cirrhosis and decompensated cirrhosis increased in the order of no SLD, MASLD, MetALD, and ALD.

CONCLUSION MASLD, MetALD, and ALD have an increased risk of PLCa, HCC, incident cirrhosis, and decompensated cirrhosis but not iCCA. These findings may serve as a robust ground for the prognostic value of the newly suggested MASLD and MetALD.

© 2023 The Author(s). Published by S. Karger AG, Basel.

Keywords

AlcoholFatty liverLiver neoplasmsNonalcoholic

Figures

Fig. 1.
Fig. 1. Flow diagram for selection of study participants. Study participants were derived from the National Health Insurance Service health screening cohort. Of the 415,139 participants without a history of cancer at baseline who were eligible for follow-up investigation, those with a history of concomitant liver diseases, those with missing information for the covariates, those with cryptogenic SLD, those who took steatosis-inducible drugs for at least 30 days, and those who underwent liver transplantation before starting follow-up were excluded.
Fig. 2.
Fig. 2. Association of SLD subtypes with the risk of PLCa. The annual incidence rate per 1,000 PYs of PLCa, HCC, iCCA is presented. SHRs (95% CIs) were calculated using the Fine-Gray model after adjustments for age, sex, body mass index, household income, antihypertensive drugs, antidiabetic drugs, antidyslipidemic drugs, aspirin, smoking, alcohol consumption, moderate-to-vigorous physical activity, and Charlson comorbidity index. Acronyms: PY, person-year; SHR, subdistribution hazard ratio; CI, confidence interval; MASLD, metabolic dysfunction-associated steatotic liver disease; MetALD, metabolic dysfunction-associated steatotic liver disease with increased alcohol intake; ALD, alcohol-associated liver disease; NA, non-applicable.
Fig. 3.
Fig. 3. Cumulative incidence function for liver-related outcomes by the subtypes of SLD. The solid lines show the cumulative incidence rates for PLCa (a), HCC (b), iCCA (c), liver cirrhosis (d), and decompensated cirrhosis (e). Liver cirrhosis and decompensated cirrhosis were evaluated among participants without any evidence of liver cirrhosis.
Fig. 4.
Fig. 4. Association of SLD subtypes with the risk of incident or decompensated cirrhosis among participants without any evidence of liver cirrhosis at baseline. SHRs (95% CIs) were calculated using the Fine-Gray model after adjustments for age, sex, body mass index, household income, antihypertensive drugs, antidiabetic drugs, antidyslipidemic drugs, aspirin, smoking, alcohol consumption, moderate-to-vigorous physical activity, and Charlson comorbidity index. Acronyms: PY, person-year; SHR, subdistribution hazard ratio; CI, confidence interval; MASLD, metabolic dysfunction-associated steatotic liver disease; MetALD, metabolic dysfunction-associated steatotic liver disease with increased alcohol intake; ALD, alcohol-associated liver disease.
Fig. 5.
Fig. 5. Restricted cubic splines for the association of alcohol consumption with the risk of liver-related outcomes. SHRs (95% CIs) were calculated using the Fine-Gray model after adjustments for age, sex, body mass index, household income, antihypertensive drugs, antidiabetic drugs, antidyslipidemic drugs, aspirin, smoking, alcohol consumption, moderate-to-vigorous physical activity, and Charlson comorbidity index. Liver cirrhosis and decompensated cirrhosis were evaluated among participants without any evidence of liver cirrhosis. Association of alcohol consumption with PLCa (a), HCC (b), iCCA (c), incident cirrhosis (d), and decompensated cirrhosis (e).

그림 출처: PubMed Central 공개 논문 (PMC11305668)

Comment · 정정

Conflict of interest statement

The authors have no conflicts to disclose.

그 밖의 정보
출판 형태
Journal Article
저널
Liver cancer · ISSN 2235-1795
전자 출판
2023-12-22
참고문헌
45편