Japan Digestive Disease Week 2025
Strategic International Session1 (S) (JSH)
October 31, 14:00–17:00, Room 9 (Portopia Hotel Main Building Kairaku 3)
ST1-1_H
Demographics and characteristics of MetALD in the U.S.
- University of California, San Diego
Background: The 2023 overarching nomenclature of steatotic liver disease (SLD) encompasses a dynamic spectrum of subcategories resulting in hepatic steatosis, namely metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol use (MetALD), and alcohol-related liver disease (ALD). This subclassification acknowledges the key concept that alcohol use and metabolic risk factors commonly coexist and contribute synergistically to liver disease development and progression. In this study, we aimed to characterize the demographics and clinical features of MetALD in a large, multiethnic, population-based cohort of community-dwelling individuals with overweight or obesity in the United States.
Methods: This is a cross-sectional analysis of a prospective study including 556 community-dwelling adults with overweight or obesity residing in Southern California. Among them, 391 had SLD, as defined by magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) ≥5%. The clinical research visit included clinical history, biochemical and phosphatidylethanol (PEth) testing, physical examination, and detailed liver disease phenotyping using MRI-PDFF and magnetic resonance elastography (MRE). Alcohol use was assessed by standardized validated questionnaires.
Results: The prevalence of MetALD in this cohort was 2.5%. Individuals with MetALD had a mean (SD) age and BMI of 54 (12) years and 31.6 (4.7) kg/m2, respectively. The MetALD population was predominantly composed by women (57%) and had a 29% prevalence of type 2 diabetes. Median (IQR) MRI-PDFF and MRE stiffness were 17.8% (11-29.7) and 2.1 kPa (1.9-2.8), respectively. The prevalence of advanced fibrosis was 7%. Sixteen percent of individuals with SLD underreported their alcohol consumption based on their PEth levels, with 16% misclassified as having MASLD and 29% misclassified as having MetALD. The use of PEth in addition to self-reported alcohol use resulted in a 4-fold increase in MetALD diagnoses.
Conclusion: In this well-characterized prospective cohort with systematic assessment using MRI-PDFF, MRE, and PEth testing, we demonstrate that MetALD is a common and frequently underdiagnosed subcategory of SLD. Incorporating objective alcohol biomarkers such as PEth alongside clinical history may enhance the accuracy of SLD subclassification.
Methods: This is a cross-sectional analysis of a prospective study including 556 community-dwelling adults with overweight or obesity residing in Southern California. Among them, 391 had SLD, as defined by magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) ≥5%. The clinical research visit included clinical history, biochemical and phosphatidylethanol (PEth) testing, physical examination, and detailed liver disease phenotyping using MRI-PDFF and magnetic resonance elastography (MRE). Alcohol use was assessed by standardized validated questionnaires.
Results: The prevalence of MetALD in this cohort was 2.5%. Individuals with MetALD had a mean (SD) age and BMI of 54 (12) years and 31.6 (4.7) kg/m2, respectively. The MetALD population was predominantly composed by women (57%) and had a 29% prevalence of type 2 diabetes. Median (IQR) MRI-PDFF and MRE stiffness were 17.8% (11-29.7) and 2.1 kPa (1.9-2.8), respectively. The prevalence of advanced fibrosis was 7%. Sixteen percent of individuals with SLD underreported their alcohol consumption based on their PEth levels, with 16% misclassified as having MASLD and 29% misclassified as having MetALD. The use of PEth in addition to self-reported alcohol use resulted in a 4-fold increase in MetALD diagnoses.
Conclusion: In this well-characterized prospective cohort with systematic assessment using MRI-PDFF, MRE, and PEth testing, we demonstrate that MetALD is a common and frequently underdiagnosed subcategory of SLD. Incorporating objective alcohol biomarkers such as PEth alongside clinical history may enhance the accuracy of SLD subclassification.