Liver and Bile

J Hepatol. 2025;83(6):1278-1291

Hansen CD, Hansen JK, Israelsen M, Andersen P, Pikkupeura LM, Lindvig KP, Stinson SE, Lindholm Schnefeld H, Tellerup J, Fogt M, Torp N, Kjærgaard M, Bech KT, Holtz Thorhauge K, Johansen S, Spedtsberg I, Deluran E, Falk Villesen I, Detlefsen S, Hansen T, Krag A, Thiele M

Prevalence, severity and determinants of steatotic liver disease among individuals with metabolic and alcohol risk from the community

Background and aims: Individuals with steatotic liver disease (SLD) are affected by metabolic dysfunction and/or high alcohol consumption; however, the prevalence of SLD in at-risk individuals remains underexplored. The study aimed to investigate the prevalence and severity of SLD and its subclasses: metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic- and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) in at-risk individuals.
Methods: Between October 2017 and November 2022, citizens aged 30–75 years were recruited 1:1 into: a) the metabolic cohort, comprising individuals with BMI > 30 kg/m2 and/or type 2 diabetes without prolonged increased alcohol consumption; or b) the alcohol cohort, comprising individuals with ongoing/prior increased alcohol consumption. The authors assessed liver steatosis by controlled attenuation parameter (CAP), liver fibrosis by liver stiffness measurements (LSM) and performed liver biopsies in participants with LSM ≥ 8 kPa.
Results: They included 3,123 participants; 1,599 in the metabolic cohort and 1,524 in the alcohol cohort. In total, 2,197 (70%) were diagnosed with SLD: 1,603 (51%) with MASLD, 398 (13%) with MetALD, and 196 (6.3%) with ALD. Of 307 (9.8%) with LSM ≥ 8 kPa, 169 underwent liver biopsy (55%). In the metabolic cohort, 1,237 (77%) had SLD, 147 (9.2%) had LSM ≥ 8 kPa, and 24 (1.5%) had biopsy-confirmed advanced liver fibrosis. In the alcohol cohort, 960 (63%) had SLD, 160 (10.5%) had LSM ≥ 8 kPa, and 46 (3.1%) had biopsy-confirmed advanced liver fibrosis. Across subclasses, ALD demonstrated the highest liver disease severity (LSM ≥ 8 kPa: 25%; biopsy-confirmed advanced fibrosis: 8%), and severity was comparable between MASLD and MetALD (LSM ≥ 8 kPa: 12%, biopsy-confirmed advanced fibrosis: 3%).

Conclusions: Among individuals with cardiometabolic and/or alcohol risk factors, 70% had SLD, 10% had elevated liver stiffness, and 2% had biopsy-confirmed advanced liver fibrosis.

DOI:  10.1016/j.jhep.2025.06.020