In 2023 nonalcoholic fatty liver disease was renamed metabolic dysfunction-associated steatotic liver disease (MASLD). A new entity was also defined: metabolic and alcohol related/associated liver disease (MetALD), corresponding to patients with MASLD with moderate alcohol consumption. In this study, we assessed the clinical and hepatic characteristics of patients with T2D with MetALD vs. MASLD.

Adult patients from NHANES 2017-2020 with complete data on transient elastography (TE) and alcohol intake were included. Diabetes was defined based on fasting plasma glucose, A1c, or prior history. Patients with secondary causes of liver steatosis were excluded. MASLD was defined as a controlled attenuation parameter (CAP) ≥288 dB/m. MetALD was defined based on CAP and self-reported alcohol use (i.e., females: 140-350 mg weekly and males: 210-420mg weekly).

Compared to MASLD (n=760), patients with T2D and MetALD (n=19; 2.4%) were younger (53 ± 15 vs. 59 ± 13 years, p=0.04) and predominantly male (89 vs. 53%, p=0.002). However, there were no significant differences in race or metabolic parameters, such as BMI (35.3 ± 9.5 vs. 34.6 ± 7.1 kg/m2, p=0.71), A1c (7.4 ± 2.6 vs. 7.4 ± 1.6%, p=0.91), triglycerides (p=0.72), HDL (p=0.90), or mean blood pressure (p=0.26). Despite metabolically similar, patients with MetALD had higher plasma AST (27 ± 9 vs. 22 ± 13, p=0.002), ALT (38 ± 23 vs. 27 ± 19, p=0.01), and GGT (p=0.01). Liver fibrosis by TE (7.9 ± 5.1 vs. 7.6 ± 5.2 kPa, p=0.82) and fat accumulation by CAP (353 ± 35 vs. 341 ± 33 dB/m, p=0.14) were similar between MASLD and MetALD.

Conclusions: MetALD represents a small percentage of patients with hepatic steatosis and T2D. Their metabolic profile is similar to MASLD patients, and despite higher liver biochemistries (i.e., ALT, AST, GGT), liver fibrosis and fat accumulation by imaging were similar in both groups. Thus, the clinical impact of this new definition in T2D is unclear. Future research is needed to determine if patients with MetALD behave similarly to patients with MASLD.

Disclosure

F. Bril: Consultant; Novo Nordisk.

© 2024 by the American Diabetes Association
2024
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