Clinical Characteristics of Steatotic Liver Disease Categories in a Large Cohort of Japanese Health Checkup Participants

Yoshihiro Kamada; Hideki Fujii; Yuichiro Suzuki; Koji Sawada; Miwa Tatsuta; Tatsuji Maeshiro; Hiroshi Tobita; Tsubasa Tsutsumi; Takemi Akahane; Chitomi Hasebe; Miwa Kawanaka; Takaomi Kessoku; Yuichiro Eguchi; Hayashi Syokita; Atsushi Nakajima; Tomoari Kamada; Hitoshi Yoshiji; Takumi Kawaguchi; Hiroshi Sakugawa; Asahiro Morishita; Tsutomu Masaki; Takumi Ohmura; Toshio Watanabe; Yoshioki Yoda; Nobuyuki Enomoto; Masafumi Ono; Kanako Fuyama; Kazufumi Okada; Naoki Nishimoto; Yoichi M Ito; Hirokazu Takahashi; Yoshio Sumida; Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

doi:10.1016/j.gastha.2024.08.006

Clinical Characteristics of Steatotic Liver Disease Categories in a Large Cohort of Japanese Health Checkup Participants

Gastro Hep Adv. 2024 Aug 10;3(8):1148-1156. doi: 10.1016/j.gastha.2024.08.006. eCollection 2024.

Authors

Yoshihiro Kamada¹, Hideki Fujii², Yuichiro Suzuki³, Koji Sawada⁴, Miwa Tatsuta⁵, Tatsuji Maeshiro⁶, Hiroshi Tobita⁷, Tsubasa Tsutsumi⁸, Takemi Akahane⁹, Chitomi Hasebe¹⁰, Miwa Kawanaka¹¹, Takaomi Kessoku^{12

13

14}, Yuichiro Eguchi¹⁵, Hayashi Syokita¹⁶, Atsushi Nakajima¹⁴, Tomoari Kamada¹⁷, Hitoshi Yoshiji⁹, Takumi Kawaguchi⁸, Hiroshi Sakugawa¹⁸, Asahiro Morishita¹⁹, Tsutomu Masaki¹⁹, Takumi Ohmura²⁰, Toshio Watanabe²¹, Yoshioki Yoda²², Nobuyuki Enomoto³, Masafumi Ono²³, Kanako Fuyama²⁴, Kazufumi Okada²⁴, Naoki Nishimoto²⁴, Yoichi M Ito²⁴, Hirokazu Takahashi²⁵, Yoshio Sumida²⁶; Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

Affiliations

¹ Department of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine 1-7, Suita, Osaka, Japan.
² Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan.
³ Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
⁴ Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa-city, Hokkaido, Japan.
⁵ Department of Gastroenterology, KKR Takamatsu Hospital 4-18 Tenjinmae, Takamatsu, Kagawa, Japan.
⁶ First Department of Internal Medicine, University of the Ryukyus Hospital, Nakagami, Okinawa, Japan.
⁷ Department of Hepatology, Shimane University Hospital, Izumo, Shimane, Japan.
⁸ Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
⁹ Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan.
¹⁰ Department of Gastroenterology, Japanese Red Cross Asahikawa Hospital, Asahikawa-city, Hokkaido, Japan.
¹¹ Department of General Internal Medicine 2, Kawasaki Medical Center, Kawasaki Medical School, Kita, Okayama, Japan.
¹² Kanagawa Dental University Yokohama Clinic, Yokohama, Kanagawa, Japan.
¹³ Department of Palliative Medicine and Gastroenterology, International University Health and Welfare Narita Hospital, Narita-shi, Chiba, Japan.
¹⁴ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
¹⁵ Loco Medical General Institute, Ogi, Saga, Japan.
¹⁶ Department of Gastroenterology, Northern OKINAWA Medical Center, Nago, Okinawa, Japan.
¹⁷ Department of Health Care Medicine, Kawasaki Medical School, Kita, Okayama, Japan.
¹⁸ Department of Gastroenterology, Heartlife Hospital, Nakagami, Okinawa, Japan.
¹⁹ Faculty of Medicine, Department of Gastroenterology and Neurology, Kagawa University, Kita-gun, Kagawa, Japan.
²⁰ Department of Health Care, Asahikawa-Kosei General Hospital, Asahikawa, Hokkaido, Japan.
²¹ Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan.
²² JA Yamanashi Koseiren Health Care Center, Kofu, Yamanashi, Japan.
²³ Division of Innovative Medicine for Hepatobiliary and Pancreatology, Faculty of Medicine, Kagawa University, Mikicho, Kagawa, Japan.
²⁴ Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
²⁵ Liver Center, Saga University Hospital, Saga, Saga, Japan.
²⁶ Graduate School of Healthcare Management, International University of Healthcare and Welfare, Minatoku, Tokyo, Japan.

Abstract

Background and aims: The clinical characteristics and risk factors involved in the development of liver fibrosis in the subtypes of steatotic liver disease (SLD) remain unknown. We examined the clinical characteristics of SLD subtypes using a large Japanese cohort.

Methods: We performed a cross-sectional analysis (total n = 108,446). In this cohort, SLD was diagnosed by ultrasonography. Individuals with none of the cardiometabolic risk factors were excluded.

Results: According to their nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) status based on the database, participants with cardiometabolic criteria were allocated to the MASLD, MASLD with increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD) with metabolic dysfunction groups. Of 30,857 subjects with SLD, 21,488 (69.6%) had NAFLD, and 20,922 (67.8%) had MASLD. There were few differences in the clinical characteristics between NAFLD and MASLD. After adjustment for clinical variables, we found that male patients with MetALD [odds ratio (OR) 2.26; 95% confidence interval (CI) 1.87-2.84] and ALD with metabolic dysfunction (OR 3.92; 95% CI 2.85-5.39) had a significantly higher risk for advanced liver fibrosis (diagnosed by Fibrosis-4 (FIB-4) index >2.67) compared to those with MASLD. In female patients with ALD, metabolic dysfunction (OR 5.80; 95% CI 2.51-13.4) and systemic blood pressure of ≥130 mmHg were significant risk factors for high FIB-4 (males: OR 3.38, 95% CI 2.51-4.55; females: OR 4.34, 95% CI 2.66-7.07, P < .001).

Conclusion: Alcohol intake and systolic blood pressure are independent contributors to liver fibrosis progression assessed by FIB-4 in SLD.

Keywords: Alcohol Intake; FIB-4 Index; Metabolic Dysfunction; Steatotic Liver Disease; Systolic Blood Pressure.