Which social determinant predicts MASLD prevalence, severity?

Among several social determinants of health (SDOHs), diet quality is most consistently associated with disease prevalence and severity in metabolic dysfunction-associated steatotic liver disease (MASLD), reports a study.

The investigators searched the databases of Medline, Embase, and Cochrane using the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. They identified studies from January 2010 to May 2024 and included quantitative studies of adults in the US that assessed SDOH beyond race/ethnicity.

The outcomes examined were prevalence of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), MASH-associated advanced fibrosis or cirrhosis, and clinical outcomes.

Eighteen studies comprising 547,634 individuals from 11 unique cohorts were included in the analysis. Of these, nine evaluated MASLD prevalence, three MASH prevalence, six MASH-associated advanced fibrosis/cirrhosis prevalence, and nine clinical outcomes.

The most consistent SDOH factor associated with both MASLD and MASH-associated advanced fibrosis/cirrhosis prevalence was high-diet quality (summarized odds ratio [SOR], 0.76; p<0.01, p=0.74, and p<0.01, respectively). Furthermore, lower income was most consistently associated with the risk of clinical outcomes (significant in three out of nine studies).

“Prospective assessments using consensus, validated tools to assess the impact of specific SDOH on MASLD burden in heterogenous patient populations are needed to inform public health interventions,” the investigators said.

“SDOHs affect disease risk and severity leading to health disparities,” they added.