Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis

Do Han Kim; Donghyun Ko; Pojsakorn Danpanichkul; Glenn Jun Kit Ho; Faith Xin Ning Tan; N. Apoorva Sasikumar; Ethan Kai Jun Tham; Daniel Q. Huang; Nicholas Syn; Ming Hua Zheng; Takumi Kawaguchi; Yoshio Sumida; Atsushi Nakajima; Hirokazu Takahashi; Mazen Noureddin; Cheng Han Ng; Mark D. Muthiah; Karn Wijarnpreecha

doi:10.1016/j.amjmed.2025.04.027

Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis

Do Han Kim, Donghyun Ko, Pojsakorn Danpanichkul, Glenn Jun Kit Ho, Faith Xin Ning Tan, N. Apoorva Sasikumar, Ethan Kai Jun Tham, Daniel Q. Huang, Nicholas Syn, Ming Hua Zheng, Takumi Kawaguchi, Yoshio Sumida, Atsushi Nakajima, Hirokazu Takahashi, Mazen Noureddin, Cheng Han Ng, Mark D. Muthiah, Karn Wijarnpreecha

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Introduction: The updated consensus introduces “steatotic liver disease” as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential. Methods: A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes. Results: A total of 13 studies, involving 17.6 million patients were included. Of these, 6.8 million individuals were diagnosed with steatotic liver disease. Subtype analysis revealed a significant increase in liver-related events and composite cardiovascular outcomes across all steatotic liver disease subtypes compared to non-steatotic liver disease. Patients with MetALD and alcohol-associated liver disease were associated with a higher risk of all-cause mortality when compared to non-steatotic liver disease. Compared to MASLD, patients with MetALD and alcohol-associated liver disease significantly elevated the risk of liver-related events and individuals with alcohol-associated liver disease were associated with increased risk of all-cause mortality. Sensitivity analysis demonstrated that certain mortality outcomes were no longer significant. Conclusion: Individuals across steatotic liver disease face an elevated risk of liver-related events, liver cancer, and cardiovascular outcomes. For liver-related events, the risk is progressively higher across MASLD, MetALD, and alcohol-associated liver disease, respectively. Misclassification may be introduced when using different diagnostic methods, leading to changes in outcomes. These findings validate the impact of the new classification in predicting outcomes.

Original language	English (US)
Pages (from-to)	1238-1247.e4
Journal	American Journal of Medicine
Volume	138
Issue number	9
DOIs	https://doi.org/10.1016/j.amjmed.2025.04.027
State	Published - Sep 2025

Keywords

Alcohol-related liver disease
Chronic liver disease
Metabolic dysfunction-associated steatotic liver disease
Humans
Fatty Liver/mortality

ASJC Scopus subject areas

General Medicine

Divisions

Gastroenterology and Hepatology

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10.1016/j.amjmed.2025.04.027

Cite this

Kim, D. H., Ko, D., Danpanichkul, P., Ho, G. J. K., Tan, F. X. N., Sasikumar, N. A., Tham, E. K. J., Huang, D. Q., Syn, N., Zheng, M. H., Kawaguchi, T., Sumida, Y., Nakajima, A., Takahashi, H., Noureddin, M., Ng, C. H., Muthiah, M. D., & Wijarnpreecha, K. (2025). Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis. American Journal of Medicine, 138(9), 1238-1247.e4. https://doi.org/10.1016/j.amjmed.2025.04.027

Kim, DH, Ko, D, Danpanichkul, P, Ho, GJK, Tan, FXN, Sasikumar, NA, Tham, EKJ, Huang, DQ, Syn, N, Zheng, MH, Kawaguchi, T, Sumida, Y, Nakajima, A, Takahashi, H, Noureddin, M, Ng, CH, Muthiah, MD & Wijarnpreecha, K 2025, 'Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis', American Journal of Medicine, vol. 138, no. 9, pp. 1238-1247.e4. https://doi.org/10.1016/j.amjmed.2025.04.027

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title = "Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis",

abstract = "Introduction: The updated consensus introduces “steatotic liver disease” as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential. Methods: A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes. Results: A total of 13 studies, involving 17.6 million patients were included. Of these, 6.8 million individuals were diagnosed with steatotic liver disease. Subtype analysis revealed a significant increase in liver-related events and composite cardiovascular outcomes across all steatotic liver disease subtypes compared to non-steatotic liver disease. Patients with MetALD and alcohol-associated liver disease were associated with a higher risk of all-cause mortality when compared to non-steatotic liver disease. Compared to MASLD, patients with MetALD and alcohol-associated liver disease significantly elevated the risk of liver-related events and individuals with alcohol-associated liver disease were associated with increased risk of all-cause mortality. Sensitivity analysis demonstrated that certain mortality outcomes were no longer significant. Conclusion: Individuals across steatotic liver disease face an elevated risk of liver-related events, liver cancer, and cardiovascular outcomes. For liver-related events, the risk is progressively higher across MASLD, MetALD, and alcohol-associated liver disease, respectively. Misclassification may be introduced when using different diagnostic methods, leading to changes in outcomes. These findings validate the impact of the new classification in predicting outcomes.",

keywords = "Alcohol-related liver disease, Chronic liver disease, Metabolic dysfunction-associated steatotic liver disease, Humans, Fatty Liver/mortality",

author = "Kim, \{Do Han\} and Donghyun Ko and Pojsakorn Danpanichkul and Ho, \{Glenn Jun Kit\} and Tan, \{Faith Xin Ning\} and Sasikumar, \{N. Apoorva\} and Tham, \{Ethan Kai Jun\} and Huang, \{Daniel Q.\} and Nicholas Syn and Zheng, \{Ming Hua\} and Takumi Kawaguchi and Yoshio Sumida and Atsushi Nakajima and Hirokazu Takahashi and Mazen Noureddin and Ng, \{Cheng Han\} and Muthiah, \{Mark D.\} and Karn Wijarnpreecha",

year = "2025",

month = sep,

doi = "10.1016/j.amjmed.2025.04.027",

language = "English (US)",

volume = "138",

pages = "1238--1247.e4",

journal = "American Journal of Medicine",

issn = "0002-9343",

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number = "9",

}

TY - JOUR

T1 - Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease

T2 - A Meta-Analysis

AU - Kim, Do Han

AU - Ko, Donghyun

AU - Danpanichkul, Pojsakorn

AU - Ho, Glenn Jun Kit

AU - Tan, Faith Xin Ning

AU - Sasikumar, N. Apoorva

AU - Tham, Ethan Kai Jun

AU - Huang, Daniel Q.

AU - Syn, Nicholas

AU - Zheng, Ming Hua

AU - Kawaguchi, Takumi

AU - Sumida, Yoshio

AU - Nakajima, Atsushi

AU - Takahashi, Hirokazu

AU - Noureddin, Mazen

AU - Ng, Cheng Han

AU - Muthiah, Mark D.

AU - Wijarnpreecha, Karn

PY - 2025/9

Y1 - 2025/9

N2 - Introduction: The updated consensus introduces “steatotic liver disease” as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential. Methods: A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes. Results: A total of 13 studies, involving 17.6 million patients were included. Of these, 6.8 million individuals were diagnosed with steatotic liver disease. Subtype analysis revealed a significant increase in liver-related events and composite cardiovascular outcomes across all steatotic liver disease subtypes compared to non-steatotic liver disease. Patients with MetALD and alcohol-associated liver disease were associated with a higher risk of all-cause mortality when compared to non-steatotic liver disease. Compared to MASLD, patients with MetALD and alcohol-associated liver disease significantly elevated the risk of liver-related events and individuals with alcohol-associated liver disease were associated with increased risk of all-cause mortality. Sensitivity analysis demonstrated that certain mortality outcomes were no longer significant. Conclusion: Individuals across steatotic liver disease face an elevated risk of liver-related events, liver cancer, and cardiovascular outcomes. For liver-related events, the risk is progressively higher across MASLD, MetALD, and alcohol-associated liver disease, respectively. Misclassification may be introduced when using different diagnostic methods, leading to changes in outcomes. These findings validate the impact of the new classification in predicting outcomes.

AB - Introduction: The updated consensus introduces “steatotic liver disease” as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential. Methods: A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes. Results: A total of 13 studies, involving 17.6 million patients were included. Of these, 6.8 million individuals were diagnosed with steatotic liver disease. Subtype analysis revealed a significant increase in liver-related events and composite cardiovascular outcomes across all steatotic liver disease subtypes compared to non-steatotic liver disease. Patients with MetALD and alcohol-associated liver disease were associated with a higher risk of all-cause mortality when compared to non-steatotic liver disease. Compared to MASLD, patients with MetALD and alcohol-associated liver disease significantly elevated the risk of liver-related events and individuals with alcohol-associated liver disease were associated with increased risk of all-cause mortality. Sensitivity analysis demonstrated that certain mortality outcomes were no longer significant. Conclusion: Individuals across steatotic liver disease face an elevated risk of liver-related events, liver cancer, and cardiovascular outcomes. For liver-related events, the risk is progressively higher across MASLD, MetALD, and alcohol-associated liver disease, respectively. Misclassification may be introduced when using different diagnostic methods, leading to changes in outcomes. These findings validate the impact of the new classification in predicting outcomes.

KW - Alcohol-related liver disease

KW - Chronic liver disease

KW - Metabolic dysfunction-associated steatotic liver disease

KW - Humans

KW - Fatty Liver/mortality

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U2 - 10.1016/j.amjmed.2025.04.027

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AN - SCOPUS:105006944893

SN - 0002-9343

VL - 138

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JO - American Journal of Medicine

JF - American Journal of Medicine

IS - 9

ER -

Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis

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