Hepatic steatosis identified in more than half of younger adults without history of MASLD
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Key takeaways:
- Hepatic steatosis was detected among 50.2% of adults younger than 45 years without history of MASLD.
- Rates of hepatic steatosis and fibrosis were higher among adults with type 2 diabetes and obesity.
Hepatic steatosis was prevalent among 52% of adults with or without type 2 diabetes and no known history of metabolic dysfunction-associated steatotic liver disease, according to findings published in Obesity.
In a cross-sectional analysis of adults who attended outpatient clinics at the University of Florida in Gainesville and had no prior diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD), researchers found 50.2% of adults younger than 45 years had hepatic steatosis and 7.5% had fibrosis. Both rates were similar to what was observed among adults aged 45 years and older. Additionally, the prevalence of steatosis and fibrosis was highest among adults with type 2 diabetes and obesity in both age groups.
“Primary care and endocrinology health care teams must screen with fibrosis-4 (FIB-4) all young adults with type 2 diabetes, obesity or cardiovascular risk factors to prevent cirrhosis from MASLD, as this study debunks the belief that young age makes metabolic liver disease unlikely,” Kenneth Cusi, MD, FACP, FACE, professor of medicine and chief of the division of endocrinology, diabetes and metabolism at the University of Florida, and a Healio | Endocrine Today Editorial Board Member, told Healio.
Researchers collected data from 1,420 adults aged 21 to 79 years with or without type 2 diabetes. Vibration-controlled transient elastography was performed to assess hepatic steatosis and clinically significant fibrosis among participants. Hepatic steatosis was defined as a controlled attenuation parameter of 288 dB/m or higher. Participants had clinically significant fibrosis if they had a liver stiffness measurement of 8 kPa or higher, a magnetic resonance elastography measure of 3 kPa or higher, or liver biopsy results indicating clinically significant fibrosis.
Hepatic steatosis was found in 52% of adults and clinically significant fibrosis was identified in 9.5% of participants. The prevalence of hepatic steatosis was 50.2% for adults younger than 45 years and 52.7% for those aged 45 years and older. Fibrosis was diagnosed among 7.5% of adults younger than 45 years and 9.9% of those aged 45 years and older. There was no significant difference in the prevalence of hepatic steatosis or fibrosis between the younger adult group and those aged 45 years and older.
Adults with type 2 diabetes or obesity were more likely to have hepatic steatosis or clinically significant fibrosis than those with neither disease (P < .01 for both). Clinically significant fibrosis was present among 15.7% of adults younger than 45 years with type 2 diabetes and obesity and 17.3% of those aged 45 years and older with type 2 diabetes and obesity. At least one metabolic syndrome risk factor was present in 98% of younger adults with hepatic steatosis and 100% of younger adults with clinically significant fibrosis.
Anu Sharma, MD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at the University of Florida, said the data indicate that providers should not ignore liver disease risk among younger adults.
“Based on the pathophysiology of MASLD, we hypothesized that rates of steatosis and fibrosis would be similar in younger and older adults when risk factors are present,” Sharma told Healio. “Our study confirmed these findings.”
In order to boost screening for fibrosis, Sharma said more accurate and noninvasive risk stratification tools are needed. Additionally, Sharma said more research is needed to find ways to slow the rising MASLD rate among younger adults.
For more information:
Kenneth Cusi, MD, FACP, FACE, can be reached at kenneth.cusi@medicine.ufl.edu.
Anu Sharma, MD, can be reached at anu.sharma@medicine.ufl.edu.
Perspective
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Scott D. Isaacs, MD, FACE, FACP
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in the United States, affecting 25% to 30% of the general population. This represents a 50% increase over the past 3 decades, with higher rates observed in individuals with obesity, type 2 diabetes, hypertension and dyslipidemia due to associated metabolic risk factors. Previous epidemiological studies have been limited by their small proportion of young adult participants and the use of less sensitive diagnostic methods for detecting steatosis and clinically significant fibrosis.
Sharma and colleagues conducted this study using sensitive detection methods to determine the prevalence of hepatic steatosis and fibrosis in adults with no known history of MASLD who attended internal medicine clinics. The study found high rates of steatosis and fibrosis in young adults (50.2% and 7.5%, respectively), that were comparable to older adults (52.7% and 9.9%). These rates were even higher in individuals with both obesity and type 2 diabetes (71.1% and 15.7%, respectively).
The presence of obesity nearly doubled the prevalence of hepatic steatosis and significantly increased the occurrence of clinically significant fibrosis. Patients with obesity showed similar rates of hepatic steatosis regardless of their type 2 diabetes status. In patients who had obesity without diabetes, the prevalence of clinically significant hepatic fibrosis increased with age. However, a novel finding of this study was that young adults with obesity and type 2 diabetes had a prevalence of fibrosis similar to older adults. This suggests that the combination of obesity and type 2 diabetes may negate the protective effect typically associated with younger age, highlighting the importance of early screening and intervention in this population.
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