Abstract

Background

Conflicting evidence regarding the prognosis of lean metabolic dysfunction-associated steatotic liver disease (MASLD) has raised substantial questions.

Aim

This study aimed to elucidate the prognosis of lean MASLD by conducting a comprehensive analysis of a vast Asian cohort.

Methods

This study used a nationwide, population-based database and analyzed 2.9 million patients. The primary endpoints were liver-related events (LREs) and cardiovascular events (CVEs) in patients with lean MASLD, non-lean MASLD, and normal liver control groups.

Results

The median observation period was 4.2 years. The 5-year incidence values of LREs in the lean MASLD, non-lean MASLD, and normal liver control groups were 0.065%, 0.039%, and 0.006%, respectively. The LRE risk of lean MASLD was significantly higher than that of normal liver control (adjusted hazard ratio [aHR]: 5.94, 95% confidence interval [CI]: 3.95–8.92) but comparable to that of non-lean MASLD (aHR: 1.35, 95% CI: 0.87–2.08). By contrast, for CVEs, the non-lean MASLD group exhibited a higher 5-year cumulative incidence rate (0.779%) than the lean MASLD (0.600%) and normal liver control (0.254%) groups. The lean MASLD group had a reduced risk of CVEs compared with the non-lean MASLD group (aHR, 0.73; 95% CI: 0.64–0.84), and comparable risk of CVEs to the normal liver control group (aHR, 0.99; 95% CI: 0.88–1.12).

Conclusion

Lean MASLD exhibits a similar LRE risk and a lower CVE risk to non-lean MASLD. Therefore, follow-up and treatment strategies should be tailored to the specific MASLD condition.

中文翻译：

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瘦肉和非瘦肉代谢功能障碍相关脂肪肝病的自然史

摘要

背景

关于瘦代谢功能障碍相关脂肪肝病 (MASLD) 预后的相互矛盾的证据提出了重大问题。

目的

本研究旨在通过对大量亚洲队列进行综合分析来阐明瘦型 MASLD 的预后。

方法

这项研究使用了全国范围内的人口数据库，分析了 290 万名患者。主要终点是瘦 MASLD、非瘦 MASLD 和正常肝脏对照组患者的肝脏相关事件 (LRE) 和心血管事件 (CVE)。

结果

中位观察期为 4.2 年。瘦MASLD组、非瘦MASLD组和正常肝脏对照组的LRE 5年发生率分别为0.065%、0.039%和0.006%。瘦 MASLD 的 LRE 风险显着高于正常肝脏对照（调整后风险比 [aHR]：5.94，95% 置信区间 [CI]：3.95–8.92），但与非瘦 MASLD 相当（aHR：1.35） ，95% CI：0.87–2.08）。相比之下，对于 CVE，非瘦 MASLD 组的 5 年累积发病率 (0.779%) 高于瘦 MASLD (0.600%) 和正常肝脏对照 (0.254%) 组。与非瘦 MASLD 组相比，瘦 MASLD 组的 CVE 风险降低（aHR，0.73；95% CI：0.64–0.84），并且 CVE 风险与正常肝脏对照组相当（aHR，0.99；95%） CI：0.88–1.12）。

结论

与非精益 MASLD 相比，精益 MASLD 表现出类似的 LRE 风险和较低的 CVE 风险。因此，应根据具体的 MASLD 病情制定随访和治疗策略。