Aims:The synergistic impact of alcohol consumption and cardiometabolic risk factors(CMRFs)on liver health remains unclear.Herein,we aimed to investigate the interplay between varying levels of alcohol consumption and ...Aims:The synergistic impact of alcohol consumption and cardiometabolic risk factors(CMRFs)on liver health remains unclear.Herein,we aimed to investigate the interplay between varying levels of alcohol consumption and the number of CMRFs on all-cause mortality in individuals with metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic and alcohol-associated liver disease(MetALD).Methods:Adult participants with ultrasound-proven hepatic steatosis were identified using the Third National Health and Nutrition Examination Survey(NHANES III)database.Multivariate Cox regression was applied to investigate the association between incremental alcohol consumption and the number of CMRFs,with all-cause mortality as the outcome.The E-value was calculated to assess the robustness of the associations,and additive interaction models were used to explore the synergistic effects of alcohol consumption and CMRFs on mortality.Results:A total of 2161 individuals(1957 with MASLD and 204 with MetALD)between the Years 1988 and 1994 were included in the analysis.During a follow-up period of 51,719 person-years,the overall mortality rate was 1.46%per person-year.Stratification by age showed an increased mortality risk associated with CMRFs and alcohol consumption in individuals aged<65 years,especially among those with 3-5 CMRFs(hazard ratio:3.15-5.71,all p<0.05).Additive interaction models also supported a synergistic effect in this subgroup,while no such trend was observed in those aged≥65 years.Conclusion:Among individuals with MASLD/MetALD and MASLD alone,a significant synergistic effect between alcohol consumption and CMRFs on mortality risk was found in those aged<65 years.This suggests an age-stratified approach for managing modifiable risk factors in individuals with MASLD or MetALD.展开更多
Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfu...Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfunction associated steatotic liver disease and increased alcohol intake(MetALD).The present retrospective cohort study examines clinical characteristics,prevalence,and mortality risk across alcoholic intake spectrum in SLD individuals.Methods:Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.Population baseline characteristics were evaluated across classifications of SLD.SLD was confirmed using either fatty liver index(FLI)or United States FLI(US-FLI).Multivariate analyses were used to study mortality-related outcomes.Results:The 20,510 individuals with SLD included were classified into MASLD predominant(69.00%),MetALD(18.77%),and ALD predominant(12.23%)groups.Temporal analysis revealed significant decreases in MASLD prevalence in the SLD population from 1999-2018 in general[average annual percentage change(AAPC)−4.802%,P=0.001],as well as in females,Mexican Americans,and Non-Hispanic Blacks.MetALD prevalence in the SLD population increased from 1999-2018 in general(AAPC+1.635%,P<0.001),and in males,females,Mexican Americans,Non-Hispanic Blacks and other ethnicities.No significant change in ALD prevalence was found.Compared to MASLD predominant individuals,ALD predominant individuals had higher risks of all-cause[hazard ratio(HR):1.189,95%confidence interval(CI):1.026 to 1.378,P=0.02]and cancer-related mortality(subdistribution HR:1.277,95%CI:1.032 to 1.579,P=0.02).No significant difference was observed for all-cause,cancer-related,or cardiovascular disease(CVD)-related mortality in MetALD and CVD-related mortality in ALD predominant individuals,relative to MASLD predominant individuals.Conclusions:ALD predominant patients have higher all-cause and cancer-related mortality risks than MASLD predominant patients but not CVD-related mortality.SLD is highly heterogeneous in clinical characteristics,prevalence,and mortality risks which healthcare professionals must account for to avert adverse health outcomes.展开更多
基金supported by the National Natural Science Foundation of China(No.82170609)NSFC-RGC Forum for Young Scholars(No.82411560273)+1 种基金Nanjing Drum Tower Hospital Academic Innovation Peak Project(No.2024-DF-03)the Natural Science Foundation of Jiangsu Province(No.BK20231118).
文摘Aims:The synergistic impact of alcohol consumption and cardiometabolic risk factors(CMRFs)on liver health remains unclear.Herein,we aimed to investigate the interplay between varying levels of alcohol consumption and the number of CMRFs on all-cause mortality in individuals with metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic and alcohol-associated liver disease(MetALD).Methods:Adult participants with ultrasound-proven hepatic steatosis were identified using the Third National Health and Nutrition Examination Survey(NHANES III)database.Multivariate Cox regression was applied to investigate the association between incremental alcohol consumption and the number of CMRFs,with all-cause mortality as the outcome.The E-value was calculated to assess the robustness of the associations,and additive interaction models were used to explore the synergistic effects of alcohol consumption and CMRFs on mortality.Results:A total of 2161 individuals(1957 with MASLD and 204 with MetALD)between the Years 1988 and 1994 were included in the analysis.During a follow-up period of 51,719 person-years,the overall mortality rate was 1.46%per person-year.Stratification by age showed an increased mortality risk associated with CMRFs and alcohol consumption in individuals aged<65 years,especially among those with 3-5 CMRFs(hazard ratio:3.15-5.71,all p<0.05).Additive interaction models also supported a synergistic effect in this subgroup,while no such trend was observed in those aged≥65 years.Conclusion:Among individuals with MASLD/MetALD and MASLD alone,a significant synergistic effect between alcohol consumption and CMRFs on mortality risk was found in those aged<65 years.This suggests an age-stratified approach for managing modifiable risk factors in individuals with MASLD or MetALD.
文摘Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfunction associated steatotic liver disease and increased alcohol intake(MetALD).The present retrospective cohort study examines clinical characteristics,prevalence,and mortality risk across alcoholic intake spectrum in SLD individuals.Methods:Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.Population baseline characteristics were evaluated across classifications of SLD.SLD was confirmed using either fatty liver index(FLI)or United States FLI(US-FLI).Multivariate analyses were used to study mortality-related outcomes.Results:The 20,510 individuals with SLD included were classified into MASLD predominant(69.00%),MetALD(18.77%),and ALD predominant(12.23%)groups.Temporal analysis revealed significant decreases in MASLD prevalence in the SLD population from 1999-2018 in general[average annual percentage change(AAPC)−4.802%,P=0.001],as well as in females,Mexican Americans,and Non-Hispanic Blacks.MetALD prevalence in the SLD population increased from 1999-2018 in general(AAPC+1.635%,P<0.001),and in males,females,Mexican Americans,Non-Hispanic Blacks and other ethnicities.No significant change in ALD prevalence was found.Compared to MASLD predominant individuals,ALD predominant individuals had higher risks of all-cause[hazard ratio(HR):1.189,95%confidence interval(CI):1.026 to 1.378,P=0.02]and cancer-related mortality(subdistribution HR:1.277,95%CI:1.032 to 1.579,P=0.02).No significant difference was observed for all-cause,cancer-related,or cardiovascular disease(CVD)-related mortality in MetALD and CVD-related mortality in ALD predominant individuals,relative to MASLD predominant individuals.Conclusions:ALD predominant patients have higher all-cause and cancer-related mortality risks than MASLD predominant patients but not CVD-related mortality.SLD is highly heterogeneous in clinical characteristics,prevalence,and mortality risks which healthcare professionals must account for to avert adverse health outcomes.
