Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study
Abstract Background The relationship between the newly proposed steatotic liver disease (SLD) subtypes—metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic alcohol-associated liver disease (MetALD)—and dementia is understudied. We evaluated the dementia risk associated with...
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2025-04-01
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| Online Access: | https://doi.org/10.1186/s12876-025-03814-1 |
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| author | Woo-Young Shin Eun Seok Kang Yun Hwan Oh Meng Sha Qiang Xia Seogsong Jeong Yoosun Cho |
| author_facet | Woo-Young Shin Eun Seok Kang Yun Hwan Oh Meng Sha Qiang Xia Seogsong Jeong Yoosun Cho |
| author_sort | Woo-Young Shin |
| collection | DOAJ |
| description | Abstract Background The relationship between the newly proposed steatotic liver disease (SLD) subtypes—metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic alcohol-associated liver disease (MetALD)—and dementia is understudied. We evaluated the dementia risk associated with these subtypes. Methods This retrospective cohort study included 296,001 participants aged over 60 who underwent health examinations between 2009 and 2010. Participants were categorized into non-SLD (reference), MASLD, and MetALD groups and followed up until dementia onset, death, or December 31, 2019. SLD was defined by a fatty liver index ≥ 30, with (i) MASLD based on cardiometabolic risk factors, and (ii) MetALD as MASLD with moderate alcohol intake. Outcomes included overall dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Subdistribution hazard ratios (SHRs) was calculated using the Fine–Gray model, treating death as a competing risk. Results Over 7,430,253 person-years of follow-up, 11,345 dementia cases occurred (10,863 AD and 2,159 VaD). Adjusted SHRs for MASLD were 1.10 (1.07–1.13) for AD and 1.20 (1.13–1.27) for VaD. For MetALD, SHRs were 0.90 (0.87–0.94) for AD and 1.53 (1.40–1.66) for VaD. Dementia risk in both MASLD and MetALD increased over longer periods, with MetALD initially linked to increased VaD risk and decreased AD risk, which reversed after three years. Conclusions MASLD and MetALD were associated with increased risks of AD and VaD; MetALD showing a stronger association with VaD. Understanding the distinct effects of different SLD subtypes on dementia is crucial for improving risk assessment and management strategies. |
| format | Article |
| id | doaj-art-eb17937cdf2c45ca82b2c9c148e00220 |
| institution | OA Journals |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-eb17937cdf2c45ca82b2c9c148e002202025-08-20T01:47:29ZengBMCBMC Gastroenterology1471-230X2025-04-0125111210.1186/s12876-025-03814-1Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort studyWoo-Young Shin0Eun Seok Kang1Yun Hwan Oh2Meng Sha3Qiang Xia4Seogsong Jeong5Yoosun Cho6Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of MedicineDepartment of Biomedical Informatics, Korea University College of MedicineDepartment of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of MedicineDepartment of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong UniversityDepartment of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong UniversityDepartment of Biomedical Informatics, Korea University College of MedicineDepartment of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of MedicineAbstract Background The relationship between the newly proposed steatotic liver disease (SLD) subtypes—metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic alcohol-associated liver disease (MetALD)—and dementia is understudied. We evaluated the dementia risk associated with these subtypes. Methods This retrospective cohort study included 296,001 participants aged over 60 who underwent health examinations between 2009 and 2010. Participants were categorized into non-SLD (reference), MASLD, and MetALD groups and followed up until dementia onset, death, or December 31, 2019. SLD was defined by a fatty liver index ≥ 30, with (i) MASLD based on cardiometabolic risk factors, and (ii) MetALD as MASLD with moderate alcohol intake. Outcomes included overall dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Subdistribution hazard ratios (SHRs) was calculated using the Fine–Gray model, treating death as a competing risk. Results Over 7,430,253 person-years of follow-up, 11,345 dementia cases occurred (10,863 AD and 2,159 VaD). Adjusted SHRs for MASLD were 1.10 (1.07–1.13) for AD and 1.20 (1.13–1.27) for VaD. For MetALD, SHRs were 0.90 (0.87–0.94) for AD and 1.53 (1.40–1.66) for VaD. Dementia risk in both MASLD and MetALD increased over longer periods, with MetALD initially linked to increased VaD risk and decreased AD risk, which reversed after three years. Conclusions MASLD and MetALD were associated with increased risks of AD and VaD; MetALD showing a stronger association with VaD. Understanding the distinct effects of different SLD subtypes on dementia is crucial for improving risk assessment and management strategies.https://doi.org/10.1186/s12876-025-03814-1Metabolic dysfunction-associated steatotic liver diseaseMetabolic alcohol-associated liver diseaseFatty liver indexDementiaAged |
| spellingShingle | Woo-Young Shin Eun Seok Kang Yun Hwan Oh Meng Sha Qiang Xia Seogsong Jeong Yoosun Cho Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study BMC Gastroenterology Metabolic dysfunction-associated steatotic liver disease Metabolic alcohol-associated liver disease Fatty liver index Dementia Aged |
| title | Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study |
| title_full | Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study |
| title_fullStr | Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study |
| title_full_unstemmed | Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study |
| title_short | Metabolic dysfunction-associated steatotic liver disease, metabolic alcohol-related liver disease, and incident dementia: a nationwide cohort study |
| title_sort | metabolic dysfunction associated steatotic liver disease metabolic alcohol related liver disease and incident dementia a nationwide cohort study |
| topic | Metabolic dysfunction-associated steatotic liver disease Metabolic alcohol-associated liver disease Fatty liver index Dementia Aged |
| url | https://doi.org/10.1186/s12876-025-03814-1 |
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