MASLD Patients Have More Comorbidities, Higher Death Risk
A higher burden of multimorbidity was seen in patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) than in individuals without MASLD, with a higher risk for all-cause mortality observed in those with MASLD and multimorbidity.
METHODOLOGY:
In this large UK-based study, researchers determined the prevalence of multimorbidity in individuals with MASLD and assessed how MASLD, alongside the extent of multimorbidity, affects all-cause mortality.
The analysis included data of 438,840 participants (mean age, 56.5 years; 42.2% men) from the UK Biobank who were recruited between 2006 and 2010.
The diagnosis of MASLD was confirmed if patients had liver steatosis (fatty liver index ≥ 60%), at least one cardiometabolic risk factor, and low alcohol consumption.
Overall, 47 long-term conditions were considered, including extrahepatic cancers; cardiovascular, metabolic, and endocrine disorders; and respiratory, digestive, renal, mental health, and congenital conditions. Multimorbidity was defined as having more than two of these long-term conditions.
The outcome was all-cause mortality, assessed over a median follow-up duration of 13 years.
TAKEAWAY:
At baseline, 29.9% of participants had MASLD, with a higher prevalence of multimorbidity than that in those without MASLD (21.3% vs 14.4%).
MASLD was associated with an increased risk for all-cause mortality (adjusted hazard ratio [aHR], 1.16; 95% CI, 1.13-1.19), with stronger effects seen in women (aHR, 1.25; 95% CI, 1.20-1.29) than in men (aHR, 1.10; 95% CI, 1.07-1.13).
Patients with MASLD were more likely to have 32 out of the 47 long-term conditions. Each additional long-term condition increased the risk for mortality by 30% in patients with MASLD (aHR, 1.30; 95% CI, 1.29-1.31) and by 38% in individuals without MASLD (aHR, 1.38; 95% CI, 1.37-1.40).
The most prevalent cardiometabolic risk factor in patients with MASLD was obesity (98.9%), and among all long-term conditions, Parkinson's disease showed the highest risk for mortality in those with MASLD (aHR, 6.09; 95% CI, 4.47-8.29).
IN PRACTICE:
"Addressing multimorbidity in MASLD patients through multidisciplinary and proactive management of multimorbidity is crucial to improving patient outcomes and reducing the overall public health impact of MASLD," the authors of the study wrote.
SOURCE:
This study was led by Qi Feng, The George Institute for Global Health (UK), School of Public Health, Faculty of Medicine, Imperial College London, London, England. It was published online on June 10, 2025, in The Journal of Clinical Endocrinology and Metabolism .
LIMITATIONS:
The predominantly White, more affluent UK Biobank cohort may not have reflected the wider UK population, further limiting the generalisability of the findings to other populations. Reliance on self-reported lifestyle data covering physical activity, smoking, and alcohol consumption may have led to information bias, potentially resulting in the misclassification of MASLD vs alcohol-related liver disease.
DISCLOSURES:
This study was supported by the National Institute for Health and Care Research Imperial Biomedical Research Centre. The authors reported having no conflicts of interest.
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