Longitudinal risk of cirrhosis by steatotic liver disease subtype among 1.5 million individuals in the US
Year: 2025
Type: article
Study design: Observational Study
Abstract: Backgound & Aims: Steatotic liver disease (SLD), which includes metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic- and alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD), is the leading cause of chronic liver disease in the US. However, the risk of disease progression varies by subtype. We aimed to evaluate long-term risks of cirrhosis and mortality across SLD subtypes in a longudinal cohort of US veterans. Methods: Adults with MASLD, MetALD, and ALD were identified using the national Veterans Affairs health system database (2010-2023). Incidence of cirrhosis and all-cause mortality was stratified by SLD subtype and analyzed using competing risks and Cox proportional hazards models, adjusted for demographic and clinical covariates. Results: <0.001). Across subtypes, relative to non-Hispanic Whites, Hispanics had higher risk and African Americans lower risk of cirrhosis. The additive effect of concurrent obesity and diabetes was associated with 36% and 22% increased risk of cirrhosis in MASLD and MetALD, respectively, compared to patients without obesity or diabetes. Conclusions: Among US veterans with SLD, the long-term risk of cirrhosis was highest in ALD, followed by MASLD and MetALD. Concurrent metabolic dysfunction and alcohol use exert a synergistic effect on cirrhosis risk, underscoring the need to aggressively address metabolic comorbidities and implement early screening and treatment for harmful alcohol use. Impact and implications: Given the growing burden of steatotic liver disease (SLD) in the US, it is crucial to understand how different causes - namely alcohol use and metabolic dysfunction - contribute to the risk of developing cirrhosis. This large, national study demonstrates that patients with alcohol-related liver disease face the highest risk, with notable variation by race and ethnicity. These findings are especially important for clinicians and healthcare systems caring for diverse populations, as they highlight groups at elevated risk who may benefit from targeted prevention and early intervention strategies. Practically, these results support the need for integrated care approaches that address both harmful alcohol use and metabolic conditions like obesity and diabetes to reduce progression to advanced liver disease.
Source: JHEP Reports
Institutions: Stanford Medicine, Stanford University, VA Palo Alto Health Care System, University of Louisville, Jewish Hospital, Louisville VA Medical Center, Universidade de São Paulo, Odense University Hospital, Universitätsklinikum des Saarlandes, Saarland University, Inova Health System, Center for Outcomes Research in Liver Diseases, Alfaisal University, Johns Hopkins University, King Faisal Specialist Hospital & Research Centre, The Graduate Center, CUNY, Barcelona Institute for Global Health, CUNY Graduate School of Public Health and Health Policy, Universitat de Barcelona
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,110
Funders: U.S. Department of Veterans Affairs, Pfizer, Gilead Sciences, City University of New York, Johns Hopkins University, University of Louisville, Inova Health System, Centres de Recerca de Catalunya, Moderna, King Faisal Specialist Hospital and Research Centre, Generalitat de Catalunya, Novo Nordisk, Odense Universitetshospital, Universität des Saarlandes, Universidade de São Paulo, Universitat de Barcelona, Ipsen, Alfaisal University, National Institutes of Health, School of Medicine, Stanford University, Agencia Estatal de Investigación
OpenAlex ID: W4416382979