MASLD Associated With Elevated Mortality From Multiple Causes, Emphasizing Need for Multidisciplinary Care
A population-based cohort study published in Journal of Hepatology, from Sweden has shown that patients with metabolic dysfunction-associated steatotic liver disease (MASLD) face significantly higher all-cause and cause-specific mortality compared to the general population, with the greatest absolute risks stemming from non-hepatocellular carcinoma (HCC) cancer and cardiovascular disease.
Using Swedish healthcare registers, researchers identified 13,099 patients with MASLD diagnosed between 2002 and 2020 and matched them to 118,884 population controls based on age, sex, municipality, and calendar year. Over a median follow-up of 4.7 years for MASLD patients, 12.4% (1,628) died, compared with 7.7% (9,119) of controls over a median 5.8-year follow-up.
MASLD was associated with a nearly twofold increase in all-cause mortality (hazard ratio [HR] 1.85; 95% CI, 1.74–1.96). Notably, elevated risks were observed across nearly all cause-of-death categories, excluding mental health disorders.
The most pronounced relative risks were seen for liver-related mortality excluding HCC (HR 26.9; 95% CI, 19.4–37.3) and for HCC-related mortality (HR 35.0; 95% CI, 17.0–72.1). However, in terms of absolute risk, the leading causes of death among MASLD patients over 15 years were non-HCC cancer (7.3%) and cardiovascular disease (7.2%).
“MASLD was strongly associated with liver- and HCC-related mortality, but the absolute risks of death were highest for non-HCC cancer and cardiovascular disease,” the authors stated.
These findings underscore the systemic nature of MASLD and the need for broader clinical vigilance. The data support the integration of hepatology, cardiology, and oncology care to address the multifactorial mortality risk.
“Mortality was increased for nearly all causes in patients with MASLD, suggesting that earlier multidisciplinary care is needed to reduce excess mortality,” the study concluded.
For practicing gastroenterologists, these results highlight the importance of proactive risk assessment and coordinated care strategies in MASLD populations, beyond liver-specific endpoints.
Reference
Issa G, Shang Y, Strandberg R, Hagström H, Wester A. Cause-specific mortality in 13,099 patients with metabolic dysfunction-associated steatotic liver disease in Sweden. Journal of Hepatology. March 2025. doi:10.1016/j.jhep.2025.03.001
