Abstract
BACKGROUND: In 2023, experts from the European and American regions proposed the concepts of steatotic liver disease (SLD) and metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD was proposed as a replacement for nonalcoholic fatty liver disease (NAFLD). We compared the long-term outcomes of patients with MASLD, NAFLD, and various subtypes of SLD. METHODS: We conducted a retrospective study using the NHANESIII database. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality and cause-specific mortality among patients with subtypes of SLD, MASLD, and NAFLD. RESULTS: During a follow-up period of 31 years (median 25 years), the adjusted risks of all-cause death for patients with MASLD was 1.19 (95% CI 1.06-1.34; P = 0.006) vs. the non-SLD group. There was a moderate level of consistency between MASLD and NAFLD (Cohen's kappa coefficient of 0.62545). Advanced fibrosis was the most serious risk factor for all-cause mortality in MASLD, and high C-reactive protein concentration was the most serious risk factor for all-cause mortality in NAFLD, followed by type 2 diabetes. CONCLUSIONS: MASLD is associated with a higher risk of all-cause mortality, and this association is independent of patients' demographic or metabolic characteristics, despite a relatively small hazard ratio. Our research findings further support that MASLD is a pathological disease related to liver disease itself. Therefore, redefining NAFLD as MASLD may help improve our understanding of predictive factors that increase the risk of death.