Prevalence, severity and determinants of steatotic liver disease among individuals with metabolic and alcohol risk from the community

BACKGROUND & AIMS: Individuals with steatotic liver disease (SLD) are affected by metabolic dysfunction and/or high alcohol consumption; however, the prevalence of SLD in at-risk individuals remains underexplored. We aimed to investigate the prevalence and severity of SLD and its subclasses: metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic- and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) in at-risk individuals. METHODS: and/or type 2 diabetes without prolonged increased alcohol consumption; or b) the alcohol cohort, comprising individuals with ongoing/prior increased alcohol consumption. We assessed liver steatosis by controlled attenuation parameter (CAP), liver fibrosis by liver stiffness measurements (LSM) and performed liver biopsies in participants with LSM ≥8 kPa. RESULTS: We included 3,123 participants; 1,599 in the metabolic cohort and 1,524 in the alcohol cohort. In total, 2,197 (70%) were diagnosed with SLD: 1,603 (51%) with MASLD, 398 (13%) with MetALD, and 196 (6.3%) with ALD. Of 307 (9.8%) with LSM ≥8 kPa, 169 underwent liver biopsy (55%). In the metabolic cohort, 1,237 (77%) had SLD, 147 (9.2%) had LSM ≥8 kPa, and 24 (1.5%) had biopsy-confirmed advanced liver fibrosis. In the alcohol cohort, 960 (63%) had SLD, 160 (10.5%) had LSM ≥8 kPa, and 46 (3.1%) had biopsy-confirmed advanced liver fibrosis. Across subclasses, ALD demonstrated the highest liver disease severity (LSM ≥8 kPa: 25%; biopsy-confirmed advanced fibrosis: 8%), and severity was comparable between MASLD and MetALD (LSM ≥8 kPa: 12%, biopsy-confirmed advanced fibrosis: 3%). CONCLUSIONS: Among individuals with cardiometabolic and/or alcohol risk factors, 70% had SLD, 10% had elevated liver stiffness, and 2% had biopsy-confirmed advanced liver fibrosis. IMPACT AND IMPLICATIONS: Steatotic liver disease (SLD) remains underdiagnosed in the general population. This study provides new population-based data on its prevalence and severity among individuals with metabolic and/or alcohol-related risk. These findings are relevant to clinicians, researchers, and public health planners, as prevalence data are essential to inform evolving screening strategies. Methodological limitations, including the cross-sectional design and limited generalizability, should be considered when interpreting the results. CLINICALTRIALS: GOV: NCT03308916.