The association between alcohol consumption and cardiometabolic factors and liver fibrosis in metabolic dysfunction‐associated steatotic liver disease and metabolic dysfunction and alcohol‐associated liver disease

Abstract

SummaryBackgroundThe relationships between alcohol consumption, cardiometabolic factors, and liver fibrosis in patients with metabolic dysfunction‐associated steatotic liver disease and those with metabolic dysfunction and alcohol‐associated liver disease remain unclear.AimsTo investigate the longitudinal associations among alcohol consumption, cardiometabolic factors, and liver fibrosis in patients with these two liver diseases.MethodsThis observational cohort study included 1866 patients with metabolic dysfunction‐associated steatotic liver disease and 521 patients with metabolic dysfunction and alcohol‐associated liver disease who underwent > two health checkups over >2 years. The associations of both liver diseases with worsening non‐invasive liver fibrosis scores were assessed using the Cox regression analysis.ResultsBoth liver diseases independently worsened liver fibrosis in both sexes. However, the hazard ratio for worsening liver fibrosis in females was significantly higher with metabolic dysfunction and alcohol‐associated liver disease than with metabolic dysfunction‐associated steatotic liver disease. Worsening liver fibrosis was not associated with alcohol consumption. Among males with metabolic dysfunction‐associated steatotic liver disease, the hazard ratio for worsening liver fibrosis was significantly higher in those with multiple cardiometabolic factors compared to those with a single cardiometabolic factor.ConclusionsAlthough both metabolic steatotic liver disease and metabolic alcohol‐associated liver disease were correlated with liver fibrosis progression in both sexes, the impact of alcohol consumption and cardiometabolic factors on fibrosis progression differed by sex. Cardiometabolic factors may have a stronger impact on liver fibrosis than alcohol consumption in males with metabolic dysfunction‐associated steatotic liver disease.