Fatty liver linked to increased risk of death from several diseases

It is estimated that one in five people in Sweden has fatty liver disease known as MASLD (metabolic dysfunction-associated steatotic liver disease), and globally it may be as many as one in four. The disease is caused by overweight or obesity and is characterised by an excessive accumulation of fat in the liver, which can lead to severe liver damage and liver cancer.

Hidden health condition

"Many people are not aware that they have fatty liver disease because it rarely causes any symptoms in the earlier stages," says Axel Wester, assistant professor at the Department of Medicine, Huddinge, Karolinska Institutet and physician at Karolinska University Hospital. "Our study shows that people diagnosed with MASLD have an increased risk of dying from many different diseases, not just liver disease."

The researchers identified all patients diagnosed with MASLD in Sweden between 2002 and 2020, more than 13,000 patients in total, and analysed their risk of death from different causes compared to the general population.

The overall mortality rate for people with MASLD was almost twice as high. The risk was elevated for nearly all causes of death studied, but especially for death from liver disease (27 times higher mortality) and liver cancer (35 times higher mortality). However, the most common causes of death were cardiovascular disease and non-liver cancer, with mortality rates 54 and 47 per cent higher, respectively.

A holistic approach

People with MASLD also had an increased risk of dying from infections, gastrointestinal diseases, respiratory diseases, endocrine diseases or external causes, but not from mental illness.

"It is important that we do not only focus on the liver when treating patients with fatty liver disease," says Hannes Hagström, adjunct professor at the Department of Medicine, Huddinge, Karolinska Institutet and senior physician at Karolinska University Hospital. "A holistic approach and early intervention involving different medical specialities can be crucial to improve the prognosis for these patients."

The study was led by Hannes Hagström and Axel Wester who share the last authorship, while Gabriel Issa, a medical student at Karolinska Institutet, is the first author. The research was funded by the Swedish Research Council, the Swedish Cancer Society, Region Stockholm, Syskonen Svensson Foundation for Medical Research, Mag-Tarmfonden, the Bengt Ihre Foundation, the Professor Nanna Svartz Foundation and the Gastroenterological Research Fund (the Swedish Society of Medicine). Hannes Hagström's institutions have received research funding from Astra Zeneca, EchoSens, Gilead, Intercept, MSD and Pfizer. He has also been a consultant for Astra Zeneca and has been part of hepatic events adjudication committees for KOWA, GW Pharma, Boehringer Ingelheim and Arrowhead.