METABOLIC dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver condition and a significant cause of liver-related illness and death. Beyond the liver, MASLD is linked to other serious diseases including cardiovascular disorders, infections, and various cancers. While prior research has mostly focused on liver-related mortality or involved small patient groups, recent large-scale studies have aimed to clarify the broader risks faced by patients with MASLD.
A recent nationwide Swedish cohort study involving over 13,000 patients with MASLD compared mortality rates and causes of death with those of the general population. The findings revealed that overall mortality was nearly twice as high among MASLD patients. Importantly, MASLD was associated with increased deaths from nearly all causes, with the strongest relative risks linked to liver diseases including hepatocellular carcinoma (HCC). However, the highest absolute risks of death were from cardiovascular disease and non-HCC cancers, which are common causes of death in both MASLD patients and the general population.
The study also demonstrated that mortality rates varied depending on disease severity. For instance, within 15 years of MASLD diagnosis, approximately 15% of patients died from cardiovascular disease or cancer, while 3% died from liver disease or HCC. Patients with cirrhosis faced even greater risks, with up to 30–37% dying from liver-related causes. These findings highlight the complex and multifaceted nature of mortality risks in MASLD.
Given the wide range of causes contributing to excess mortality, the study underscores the need for early multidisciplinary care. This care approach should involve primary care physicians, hepatologists, cardiologists, and other specialists to address both liver disease and associated conditions. Such comprehensive management may improve patient outcomes by targeting cardiovascular health, cancer prevention, and liver disease progression.
The study’s strength lies in its large, contemporary population and robust data sources. However, limitations include a lack of detailed liver fibrosis staging and potential selection bias since many patients were diagnosed in hospital settings. Despite these challenges, the research provides valuable insights for clinicians and policymakers to better inform patients and develop effective strategies to reduce premature mortality in MASLD.
Reference
Issa G et al. Cause-specific mortality in 13,099 patients with metabolic dysfunction-associated steatotic liver disease in Sweden. J Hepatol. 2025;DOI:10.1016/j.jhep.2025.03.001.
