Natural history and outcomes of MASLD and MetALD following non-alcoholic fatty liver disease reclassification in a Canadian cohort
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Date
2025
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Abstract
Introduction and Objectives: Steatotic liver disease (SLD) affects 40 % of North Americans, with some progress-ing to advanced fibrosis. A recent nomenclature update redefined subtypes, distinguishing Metabolic dys-function-associated steatotic liver disease (MASLD), Metabolic and alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD). This study aimed to assess the prevalence of MetALD and ALD in a previously Non-alcoholic fatty liver disease (NAFLD) -labeled cohort, evaluate cardiometabolic risk factors, and analyze short-term outcomes.Materials and Methods: This retrospective observational cohort study included patients referred to a special-ized NAFLD clinic in Ontario, Canada (October 2021−September 2023). Adults (age ≥18 years) with radio-graphic hepatic steatosis were categorized into MASLD, MetALD, or ALD based on gender-specific alcohol consumption thresholds documented in electronic medical records. Baseline characteristics and short-term outcomes were compared across groups.Results: Among 445 patients, MASLD was most prevalent (88.3 %), followed by MetALD (8.9 %) and ALD (2.7 %). Males predominated in MetALD (67.5 %) and ALD (83.4 %) (p = 0.002). Smoking was strongly linked to ALD (p = 0.001). Diabetes was more common in MASLD (32.5 %, p = 0.012), while hypertension and dyslipide- mia showed no significant differences across SLD subtypes. Advanced fibrosis (F3-F4) was present in 16.1 %. In a two-year follow-up, higher mortality incidences were observed in ALD (16.6 %). Additionally, regression of fibrosis was observed across all groups.Conclusions: 11.7 % of patients historically labeled as NAFLD met criteria for MetALD or ALD, underscoring the importance of updated nomenclature. High fibrosis prevalence and ALD-related mortality highlight the need for early screening, precise alcohol assessment, and multidisciplinary care to improve outcomes.
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Alcohol-associated liver disease, Fibrosis progression, Cardiometabolic risk factors, Prevalence