Background and purpose
Metabolic dysfunction-associated fatty liver disease (MASLD) affects approximately 32% of the U.S. adult population. This study aimed to simultaneously assess the effects of seven metabolic risk factors (MRFs), ethnicity and age, and clinical symptoms of MASLD, utilizing a large cohort linked to All of Us electronic health records.
method
This study included a MASLD group (n = 15,060) and a frequency-matched control group (n = 75,300). Multivariate analysis was performed to compare the frequency of MRF and clinical outcomes between the two groups. Type 1 diabetes was not included in the multivariate analysis. Subgroup analyzes were conducted according to race, ethnicity, and age.
result
The overall frequency of MASLD was 6.0%. Compared with controls, MASLD patients had significantly higher independent frequencies of obesity (66.1% vs. 41.3%), type 2 diabetes (39.5% vs. 16.9%), hypertension (64.3% vs. 38.6%), hyperlipidemia (59.8% vs. 37.3%), and obstructive sleep apnea (28.9% vs. 41.3%). 13.4%) and hypothyroidism (21.2% vs. 13.4%). Obesity was found to be the strongest independent MRF among Asians, whites, and Hispanics, especially those under 50 years of age, whereas hypertension was the strongest independent MRF among blacks. MASLD was also associated with a significantly higher frequency of cardiac events, including coronary artery disease (17.1% vs. 9.4%) and myocardial infarction (7.1% vs. 4.2%). Liver events including cirrhosis (7.5% vs. 1.1%) and hepatocellular carcinoma (0.5% vs. 0.1%). They also had elevated liver enzymes such as alanine aminotransferase (27.7% vs. 10.1%), aspartate aminotransferase (18.0% vs. 6.4%), and alkaline phosphatase (19.8% vs. 13.1%) compared to the control group.
conclusion
Although our study showed that obesity, hypertension, hyperlipidemia, type 2 diabetes, obstructive sleep apnea, and hypothyroidism are independent MRFs for overall MASLD, the ranking of these MRFs by odds ratio may vary by ethnicity and age. MASLD has significantly elevated rates of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase, as well as cardiac and hepatic events.
sauce:
Reference magazines:
Hu, K.-Q., others. (2026). Clinical manifestations of fatty liver disease associated with metabolic risk factors and metabolic dysfunction using data from all of us research program. Journal of Clinical and Translational Hepatology. DOI: 10.14218/jcth.2025.00393. https://www.xiahepublishing.com/2310-8819/JCTH-2025-00393
