A recent study led by researchers at Karolinska Institutet in Sweden has found that people with fatty liver disease have nearly double the risk of mortality compared with the rest of the population. The study, published in The Journal of Hepatology, shows that people with metabolic dysfunction-associated steatotic liver disease (MASLD) have an increased risk of death not just from liver-related issues, but also from common diseases like cardiovascular conditions and cancer.
“Our study shows that people diagnosed with MASLD have an increased risk of dying from many different diseases, not just liver disease,” said Axel Wester, MD, PhD, an assistant professor in the department of medicine at Karolinska Institutet and the study’s senior author.
For this research, the Karolinska team tracked more than 13,000 patients diagnosed with MASLD in Sweden between 2002 and 2020, and compared their mortality rates with a matched control group of nearly 119,000 individuals from the general population. They found that the strongest associations between MASLD and increased mortality were observed in cases of liver disease and liver cancer, with mortality rates 27 times and 35 times higher, respectively.
But the most common causes of death in the MASLD patients were cardiovascular disease and non-liver cancers, with mortality rates 54% and 47% higher, respectively.
“It is important that we do not only focus on the liver when treating patients with fatty liver disease,” said Hannes Hagström, MD, an adjunct professor of hepatology at Karolinska Institutet and senior physician at Karolinska University Hospital. “A holistic approach and early intervention involving different medical specialties can be crucial to improve the prognosis for these patients.”
The study used Swedish healthcare registers to identify patients with MASLD, employing statistical methods such as Cox regression to adjust for potential confounders. Researchers calculated hazard ratios (HRs) to determine the relative risk of death from various causes, comparing MASLD patients with their healthy counterparts. The findings show that while liver disease and liver cancer were the most directly linked to MASLD, patients were also at a significantly higher risk of dying from infections, gastrointestinal diseases, respiratory issues, endocrine disorders, and external causes.
The study’s authors say their findings highlight the need for more comprehensive care for people with MASLD. In particular, they suggest a shift toward earlier, multidisciplinary intervention. “Primary care is central in an efficient model of care for MASLD for early detection, risk stratification, and early disease management including risk factor modification,” the researchers wrote.
The hope is that this new information can provide more precise risk estimates for patients that can be used by clinicians to help guide treatment strategies for those with MASLD. The study also suggests that addressing the increased risks of cardiovascular disease and cancer, which contribute to the highest absolute mortality, should be a focus of clinical care.
The next steps for this line of inquiry will involve continued refinement of disease risk associated with MASLD and developing additional data on disease progression and treatments. The researchers also suggested that further studies could evaluate the impact of early interventions across multiple specialties focused on reducing mortality.
