Comparative analysis of cirrhosis and hepatocellular carcinoma outcomes in Asian populations with non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatohepatitis liver disease (MASLD): A five-year retrospective study.

Abstract

78 Background: Metabolic Dysfunction-Associated Steatohepatitis Liver Disease (MASLD) represents the most up-to-date definition of Non-Alcoholic Fatty Liver Disease (NAFLD) for Asian populations, acknowledging that manifestations may differ across racial/ethnic groups. Due to metabolic and anthropometric differences, adapted criteria for MASLD have been proposed for Asian adults. This analysis aims to compare clinical outcomes between Asian patients diagnosed with MASLD and those with NAFLD. Methods: In this retrospective analysis, 48,189 Asian adults suspected of having MASLD were identified from the TriNetX global research network between January 1, 2010 and December 31, 2023. An equal number of patients (48,189) diagnosed with NAFLD were matched on a 1:1 basis with MASLD patients through propensity score matching. MASLD criteria were adapted to be Asia-specific, requiring a Body Mass Index (BMI) of ≥23 along with the presence of four aspects of metabolic dysfunction. Over a 5-year follow-up period, primary outcomes of cirrhosis and hepatocellular carcinoma (HCC) incidences were determined using Kaplan-Meier methods. Cumulative incidence curves depicted the rates of these events over time. Hazard ratios (HR) for the outcomes were calculated using Cox regression models to estimate the risk associated with MASLD. Results: Over 5 years, the cumulative incidence of cirrhosis (3.0% vs 3.0%, p=0.800) and HCC (1.3% vs 1.4%, p=0.695) were numerically lower in MASLD compared to NAFLD patients, respectively. Adjusted HRs for MASLD were: cirrhosis 1.00 (0.87-1.14) and HCC 0.86 (0.68-1.10). Conclusions: This study compared the clinical outcomes of MASLD and NAFLD in Asian populations and found no significant differences in identifying the risk of cirrhosis and hepatocellular carcinoma between the two diagnostic criteria. However, introducing the new term and diagnostic criteria of MASLD helps reduce the stigmatization associated with NAFLD, emphasizing the central role of metabolic dysfunction in disease occurrence. Although this study did not find significant differences between MASLD and NAFLD in predicting cirrhosis and hepatocellular carcinoma, the concept of Asian-specific diagnostic criteria remains important, highlighting that disease manifestations and risk factors may vary across different races and populations, necessitating personalized prevention and treatment strategies for specific populations. Future research should further explore the similarities and differences between MASLD and NAFLD in different Asian subgroups to optimize diagnostic criteria, improve the accuracy of risk prediction, and develop targeted interventions.