From 02/11/2025:
Study Finds 3 in 4 Overweight, Obese Adults Have Steatotic Liver Disease MASH
As much as 75% of overweight and obese individuals have steatotic liver disease, according to results of a recent cross-sectional, observational study.
In addition, the study further delved into subcategories of steatotic liver disease (SLD), finding that in this population, the prevalences of metabolic dysfunction–associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and mixed metabolic dysfunction and ALD were 67.3%, 2.6% and 4.8%, respectively. The prevalences of advanced fibrosis and cirrhosis were 10.8% and 4.5%, respectively.
The study focused on adults 40 to 75 years of age with a body mass index of 25 kg/m2 or higher recruited from primary care and community settings in Southern California (Gut 2024;73[12]:2045-2053). The researchers assessed the prevalence of SLD-related conditions, advanced fibrosis and cirrhosis in these patients using advanced MRI techniques, including MRI proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). They found significant associations between advanced fibrosis and factors such as metabolic syndrome, diabetes mellitus and obesity, as well as notable differences in liver biomarkers and imaging characteristics between people with and without advanced fibrosis.
Improved Accuracy With Prospective Data
Previous studies that did not focus on overweight and obese patients showed a much lower prevalence of SLD. For instance, according to data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), the prevalence of SLD—defined as a controlled attenuation parameter (CAP) larger than 300 dB/m—was found to be 28.8% (Dig Dis Sci 2023;68[4]:1237-1252).
This latest study is different in two main ways, according to senior investigator Rohit Loomba, MD, MHSc, the chief of gastroenterology and hepatology at the University of California, San Diego and director of the UCSD MASLD Research Center.
“Our study focuses on adults with obesity from Southern California. In contrast, the NHANES study surveys a much broader population of adults and children, including individuals with normal BMI, from across the United States.”
In addition, “our cohort study is the first to examine the prevalences of SLD subcategories using advanced MRI methods such as MRI-PDFF and 2D MRE along with CAP and vibration-controlled transient elastography [VCTE]. This rigorous phenotyping approach lends credibility to our findings,” Dr. Loomba told GEN Priority Report. “Furthermore, phosphatidylethanol levels are unavailable in NHANES or any previous study of SLD, which represents another major strength of this study, given its prospective study design.”
Data to Improve Screening
Jonathan G. Stine, MD, MSc, an associate professor of medicine and public health sciences at Penn State College of Medicine and the research director at Penn State Health Liver Center, in Hershey, Pa., told GEN Priority Report that the study’s findings are “highly significant.”
“The study suggests that SLD is more common in these [overweight and obese] individuals than previously thought, which could prompt earlier and more aggressive screening and intervention strategies, potentially altering the standard of care or at least furthering conversation about a high-risk population to screen,” said Dr. Stine, who was not involved with the research.
Dr. Loomba agreed, saying his findings “lend additional support for the American Association for the Study of Liver Diseases practice guidance [Hepatology 2023;77(5):1797-1835], which states that patients with obesity have a higher risk of MASLD and may be considered for screening using the FIB-4 [Fibrosis-4] index as a starting point.”