An analysis of 2017 to 2018 National Health and Nutrition Examination Survey data revealed that metabolic dysfunction–associated steatotic liver disease affected an estimated 42.4% of U.S. adults, with significant racial and ethnic disparities in disease prevalence and risk factors.
In the cross-sectional study, published in Communications Medicine, investigators analyzed data from 5,532 individuals aged > 15 years with a mean age of 45.4 years, 50.9% of whom were women. The study population comprised 61.5% non-Hispanic White, 11.4% Black, 16.4% Hispanic, 5.7% Asian, and 5.0% other races/ethnicities.
Using controlled attenuation parameter ≥ 288 dB/m, liver stiffness ≥ 7.2 kPa, or elevated aminotransferases (AST/ALT > 25 U/L in women, > 35 U/L in men), the investigators identified steatotic liver disease following the 2023 consensus criteria based on weekly alcohol consumption: metabolic dysfunction–associated steatotic liver disease (MASLD) (< 140 g women, < 210 g men), MetALD (140 to 350 g women, 210 to 420 g men), and ALD (> 350 g women, > 420 g men).
The adjusted prevalence rates were 42.4% for MASLD (95% confidence interval [CI] = 41.1%–43.8%), 1.7% for MetALD (95% CI = 1.3%–2.0%), and 0.6% for ALD (95% CI = 0.3%–0.8%). In the 15 to 39 age group, rates were 29.8% for MASLD, 1.7% for MetALD, and 1.1% for ALD.
Laboratory findings revealed median values among patients with MASLD: AST 21 U/L, ALT 23 U/L, fasting glucose 108 mg/dL, glycated hemoglobin 5.7%, triglycerides 138 mg/dL, and controlled attenuation parameter 312 dB/m.
The study identified a significant cardiometabolic burden, with 87.5% of participants meeting at least one criterion: 73.2% were overweight/obese, 52.4% had abnormal glucose metabolism, 43.1% had hypertension, 32.1% had hypertriglyceridemia, and 37.2% had low high-density lipoprotein or used lipid-lowering agents.
Hispanic patients showed higher overweight/obesity prevalence vs non-Hispanic White patients (78.8% vs 69.2%, P < .0001). Asian participants demonstrated higher T2DM prevalence (13.7% vs 10.7%, P = .039), while Black patients showed higher hypertension rates (52.1% vs 43.7%, P = .002).
Multivariable analysis revealed independent risk factors for MASLD, including male sex (odds ratio [OR] = 1.30, P = .019), ages 40 to 64 years (OR = 1.69, P < .0001), Hispanic ethnicity (OR = 1.49, P = .012), increased body amss index (OR = 1.16, P < .0001), T2DM (OR = 1.92, P = .001), hypertension (OR = 1.46, P = .010), and hypertriglyceridemia (OR = 1.75, P < .0001).
The study found dose-dependent relationships between abnormal weight and SLD risk, with ORs of 2.86 for increased adiposity (P = .009), 4.30 for overweight (P < .0001), and 16.04 for obesity (P < .0001). Similar relationships existed for abnormal glucose metabolism (OR = 2.49 for prediabetes, OR = 7.13 for T2DM, P < .0001).
Study limitations included reliance on self-reported alcohol consumption data, lack of liver biopsy confirmation, and potential underestimation of MetALD and ALD prevalence because of recall bias and underreporting of alcohol use. The investigators noted that standardized alcohol use quantification methods and biomarkers could improve future prevalence estimates.
Conflict of interest disclosures can be found in the study.
