Three cardiometabolic risk factors linked to higher mortality in MASLD liver disease, study finds

Three cardiometabolic risk factors — high blood pressure, type 2 diabetes and low levels of high-density lipoprotein (HDL) cholesterol — are associated with a markedly higher risk of death from MASLD, a form of fatty liver disease not tied to heavy drinking. The finding comes from a US study that analyzed health records of more than 134,000 people between 1988 and 2018, with 21,872 identified as having MASLD and at least one metabolic risk factor.

Researchers found that high blood pressure alone increased the risk of MASLD-related death by about 40 percent. Those with type 2 diabetes and low HDL raised the risk by roughly 25 percent and 15 percent, respectively. When patients carried multiple metabolic risk factors, the combined effect rose further, with each additional factor associated with a 15 percent higher risk of death for MASLD patients, after adjusting for age and sex. The study was published in Clinical Gastroenterology, with lead author Dr. Matthew Dukewich, a transplant hepatology fellow at the University of Southern California, describing the finding as a key new insight. He said, "Until now, it was commonly thought that diabetes was the most pressing health problem for MASLD patients, which is a key insight."

Dr. Norah Terrault, a hepatologist at USC and co-author, added: "MASLD is a complicated disease, and this study sheds new light on where doctors may want to focus their efforts when treating patients. Knowing which aspects of MASLD might lead to poorer outcomes can help us offer patients the best possible care." In the study, researchers assessed health data from over 134,000 people between 1988 and 2018. They discovered 21,872 volunteers had MASLD and at least one cardiometabolic risk factor, such as obesity or high blood pressure. After accounting for factors that could skew the results, such as age and gender, they found high blood pressure, type 2 diabetes and low HDL cholesterol were the three cardiometabolic risk factors linked to the highest risk of MASLD death—raising this risk by 40, 25 and 15 percent respectively. Writing in Clinical Gastroenterology, they also discovered that each additional metabolic risk factor increased the risk of death for MASLD patients by 15 percent. Medics should consider prioritising MASLD patients with cardiometabolic risk factors, they added.

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Where liver disease was once largely confined to the elderly and heavy drinkers, it is now rising rapidly among younger adults. In the UK, the British Liver Trust estimates MASLD may affect one in five people, though experts have warned the true figure could be as high as 40 percent. Undiagnosed cases are common, with around 80 percent of those affected unaware they have MASLD because the disease often has no obvious symptoms or is detected only during routine blood tests or liver function tests carried out for unrelated issues. The broader diabetes picture in the UK is stark: diabetes now affects about 4.6 million people, a record high according to Diabetes UK, while about 14 million UK adults live with high blood pressure, a figure that continues to rise. In children, cases of MASLD have doubled over the past two decades, underscoring the growing public health challenge.

Experts say medics should consider prioritising MASLD patients with cardiometabolic risk factors to improve outcomes and tailor treatment strategies. The study reinforces the link between liver disease and metabolic health and suggests that addressing blood pressure, blood sugar and HDL levels could influence MASLD trajectories as the condition becomes more common across age groups. In the United States and the United Kingdom alike, clinicians are increasingly calling for integrated care approaches that target the broader metabolic profile of MASLD patients to slow disease progression and reduce mortality risk.