Introduction This study aimed to investigate the liver-related outcomes of newly suggested metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake (MetALD), as well as alcohol-associated liver disease (ALD). Methods From a National Health Insurance Service Health Screening Cohort, we included 369,094 participants who underwent health checkups between 2009 and 2010 in South Korea. Steatotic liver disease (SLD) was defined as a fatty liver index ≥60. The risk of primary liver cancer (PLCa), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), incident cirrhosis, and decompensated cirrhosis was compared with no SLD. The subdistribution hazard ratio (SHR) was calculated using the Fine-Gray model regarding competing risks. Results A total of 3,232 participants (0.9%) developed PLCa during the median follow-up of 3,227,176 person-years: 0.5% with no SLD, 1.1% with MASLD, 1.3% with MetALD, and 1.9% with ALD. Competing risk analysis revealed that compared with no SLD, MASLD (SHR: 1.65; 95% CI: 1.44-1.88), MetALD (SHR: 1.87; 95% CI: 1.52-2.29), and ALD (SHR: 1.86; 95% CI: 1.39-2.49) were associated with an increased risk of PLCa. MASLD (SHR: 1.96; 95% CI: 1.67-2.31), MetALD (SHR: 2.23; 95% CI: 1.75-2.84), and ALD (SHR: 2.34; 95% CI: 1.67-3.29) were associated with a higher risk of HCC. No significant difference was observed in the risk of iCCA. The risk of incident cirrhosis and decompensated cirrhosis increased in the order of no SLD, MASLD, MetALD, and ALD. Conclusion MASLD, MetALD, and ALD have an increased risk of PLCa, HCC, incident cirrhosis, and decompensated cirrhosis but not iCCA. These findings may serve as a robust ground for the prognostic value of the newly suggested MASLD and MetALD.

中文翻译：

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代谢功能障碍相关的脂肪性肝病和代谢功能障碍相关的脂肪性肝病与酒精摄入量增加会增加患肝细胞癌和意外或失代偿性肝硬化的风险：一项韩国全国性研究。


简介 本研究旨在调查新提出的代谢功能障碍相关脂肪性肝病 (MASLD) 和酒精摄入增加的 MASLD (MetALD) 以及酒精相关性肝病 (ALD) 的肝脏相关结局。方法 我们从国家健康保险服务健康筛查队列中纳入了 2009 年至 2010 年间在韩国接受健康检查的 369,094 名参与者。脂肪肝病（SLD）被定义为脂肪肝指数≥60。将原发性肝癌 (PLCa)、肝细胞癌 (HCC)、肝内胆管癌 (iCCA)、偶发性肝硬化和失代偿性肝硬化的风险与无 SLD 的风险进行比较。使用有关竞争风险的细灰色模型计算次分布风险比 (SHR)。结果 在 3,227,176 人年的中位随访期间，共有 3,232 名参与者 (0.9%) 出现 PLCa：0.5% 没有 SLD，1.1% 患有 MASLD，1.3% 患有 MetALD，1.9% 患有 ALD。竞争风险分析显示，与无 SLD 相比，MASLD（SHR：1.65；95% CI：1.44-1.88）、MetALD（SHR：1.87；95% CI：1.52-2.29）和 ALD（SHR：1.86；95% CI：1.44-1.88）和 ALD（SHR：1.86；95% CI） ：1.39-2.49）与 PLCa 风险增加相关。 MASLD（SHR：1.96；95% CI：1.67-2.31）、MetALD（SHR：2.23；95% CI：1.75-2.84）和 ALD（SHR：2.34；95% CI：1.67-3.29）与较高的风险相关。肝癌的风险。 iCCA 风险没有观察到显着差异。发生肝硬化和失代偿性肝硬化的风险按无 SLD、MASLD、MetALD 和 ALD 的顺序增加。结论 MASLD、MetALD 和 ALD 会增加 PLCa、HCC、偶发性肝硬化和失代偿性肝硬化的风险，但不会增加 iCCA 的风险。这些发现可能为新提出的 MASLD 和 MetALD 的预后价值提供坚实的基础。