Threefold higher rate of cirrhosis, HCC linked to alcohol overconsumption in MASLD
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Key takeaways:
- Patients with MASLD and existing alcohol-related disease had higher rates of major adverse liver outcomes (19.5% vs. 7.8%).
- Careful assessment of alcohol consumption at time of MASLD diagnosis is critical.
Around 17% of patients with metabolic dysfunction-associated steatotic liver disease have or will be diagnosed with alcohol-related disease, which research shows is associated with a threefold higher rate of developing cirrhosis or cancer.
“For the diagnosis of MASLD, one must exclude alcohol overconsumption as an etiology,” Patrik Nasr, MD, PhD, adjunct associate professor in the division of diagnostics and specialist medicine at Linköping University, and colleagues wrote in Clinical Gastroenterology and Hepatology. “However, recent studies have highlighted that undisclosed alcohol consumption may be more common than previously considered. ... How common this is in real-life practice and the impact such misclassification might have on prognosis is unknown.”
In a population-based cohort study, Nasr and colleagues identified 15,107 Swedish patients (median age, 55 years; 52% women) with MASLD between 1987 and 2020, 12% of whom had a diagnosis of alcohol-related liver disease (ALD) or alcohol use disorder (AUD) at or before MASLD diagnosis. More than two-thirds (67%) had only AUD and 11% had only ALD, while 5% had other alcohol-related diagnoses.
Researchers defined the primary outcome as time to first major adverse liver outcome (MALO) of cirrhosis or hepatocellular carcinoma.
During a median follow-up of 5.2 years, an additional 5.2% of patients received a diagnosis of ALD or AUD and 9.2% of the full cohort developed any MALO. Those with a previous ALD or AUD diagnosis had higher rates of MALOs compared with those who had only MASLD (19.5% vs. 7.8%; adjusted HR = 3.12; 95% CI, 2.74-3.55), which corresponded with incidence rates of 44 per 1,000 person-years vs. 10 per 1,000 person-years (aHR = 3.12; 95% CI, 2.74-3.59), respectively.
Moreover, receiving an ALD or AUD diagnosis after diagnosis with MASLD correlated with higher rate of incident MALO (aHR = 5.81; 95% CI, 4.9-6.88).
“Around 17% of patients with a diagnosis of MASLD have, or will receive, a diagnosis of alcohol-related liver disease or alcohol use disorder at some point in their life course,” Nasr and colleagues concluded. “Such patients have a considerably higher rate of progression to cirrhosis or HCC.”
They continued: “Careful assessment of alcohol consumption at the diagnosis of MASLD and thereafter is paramount to predicting the future risk of cirrhosis and allow for accurate treatment.”
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