Prevalence and risk factors for metabolic dysfunction–associated steatotic liver disease in Sweden: Insights from the SCAPIS cohort

Abstract

Background and Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most common chronic liver disease globally, but its prevalence and severity remain poorly characterized in the general population. Our aim was to estimate the prevalence of MASLD and the risk of advanced fibrosis in a large Swedish general population cohort. Methods: From the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort, we analyzed 27,763 participants aged 50–64 years who underwent extensive clinical characterization. MASLD was defined as <48 HU on non-contrast liver computed tomography (CT) imaging. The risk for advanced fibrosis was assessed using the dynamic aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio. Results: MASLD was present in 18.1% of participants and was more common in men than women (25.5% vs. 11.2%). Prevalence increased with cardiometabolic burden: from 7.0% among those without obesity, hypertension, or Type 2 diabetes mellitus (T2DM) to 70.2% among those with all three conditions. MASLD risk was elevated in individuals with obesity alone (adjusted odds ratio [aOR] 5.56; 95% CI = 4.89–6.31), T2DM alone (aOR = 2.66; 95% CI = 2.13–3.33), or hypertension alone (aOR = 1.78; 95% CI = 1.59–1.99). The combination of all three conferred the highest risk (aOR = 17.1; 95% CI = 14.0–20.9). Among persons with MASLD, 24.8% were classified as at risk for advanced fibrosis. Fibrosis risk was independently associated with hypertension (aOR = 1.44; 95% CI = 1.24–1.66), T2DM (aOR = 1.24; 95% CI = 1.06–1.46), male sex (aOR = 1.20; 95% CI = 1.02–1.42), and alcohol consumption (aOR per gram/day = 1.02; 95% CI = 1.01–1.03). Conclusions: In Sweden, almost one in five middle-aged adults is affected by MASLD, with a quarter of cases at risk of advanced fibrosis. Male sex, obesity, T2DM, and hypertension are important predictors of the prevalence and severity of MASLD.