TOPLINE:

Among subgroups of steatotic liver disease (SLD), metabolic dysfunction and alcohol-associated liver disease (MetALD) and alcohol-related liver disease (ALD) were associated with a higher risk for extrahepatic cancers than metabolic dysfunction-associated SLD (MASLD).

METHODOLOGY:

• Researchers in England conducted a retrospective observational cohort study to assess the incidence of cardiovascular events and extrahepatic cancers across SLD subgroups.
• They included 739 patients with biopsy-confirmed SLD (mean age, 51 years; 63% men) between 1999 and 2024. The median follow-up duration was 6.3 years.
• Patients were classified as those with MASLD (n = 525), MetALD (n = 88), and ALD (n = 126) on the basis of the presence of cardiometabolic risk factors and alcohol consumption at baseline.
• MASLD was defined as the presence of at least one cardiometabolic risk factor with minimal alcohol consumption (< 210 g/wk for men and < 140 g/wk for women); MetALD was defined as MASLD with an increased consumption of alcohol (210-420 g/wk for men and 140-350 g/wk for women); and ALD was defined as a significant consumption of alcohol (> 420 g/wk for men and > 350 g/wk for women).
• Five-year cumulative incidences of extrahepatic cancers and cardiovascular events — including ischaemic heart disease, peripheral vascular disease, cerebrovascular disease, and heart failure — were evaluated.

TAKEAWAY:

• During the follow-up period, 60 cardiovascular events were noted among 50 patients, with ischaemic heart disease being the most common (46.6%), and 55 patients developed incident extrahepatic cancers, most commonly skin cancer (25.9%) and prostate cancer (13%).
• The 5-year cumulative incidence of cardiovascular events was 7.4% in patients with MetALD, 5.3% in those with MASLD, and 3.2% in those with ALD. The 5-year cumulative incidence of extrahepatic cancers was 4.9% in patients with MetALD, 4.3% in those with ALD, and 3.4% in those with MASLD.
• In multivariable competing risk regression analysis, patients with MetALD (subdistribution hazard ratio [sHR], 2.43; P = .021) and those with ALD (sHR, 1.97; P = .040) had a higher risk for extrahepatic cancers than those with MASLD. Increasing age was independently associated with the risk for extrahepatic cancer (sHR, 1.05; P < .001).
• No significant associations were observed between SLD subgroups and cardiovascular events in the multivariable analysis.

IN PRACTICE:

"MetALD represents a unique subgroup characterized by a synergistic metabolic and alcohol risk profile, associated with increased risk of extrahepatic malignancy and HCC [hepatocellular carcinoma], while differences in cardiovascular outcomes remain less clearly defined. These results highlight the importance of accurate alcohol assessment, subgroup-specific management, and targeted surveillance strategies within the SLD spectrum," the authors wrote.

SOURCE:

This study was led by Katrina Pekarska, St James's University Hospital, Leeds, England. It was published online on June 02, 2026, in Digestive Diseases and Sciences.

LIMITATIONS:

The possibility of bias cannot be ruled out because of the single-centre retrospective design and the lack of data on changes in the consumption of alcohol over time. The inclusion period of 25 years may have introduced heterogeneity due to differences in treatment and management of risk factors. The study included only patients who underwent liver biopsy, which may have led to selection bias.

DISCLOSURES:

No funding was received for this study. One author declared receiving consultancy fees, advisory board fees, speaking fees, and support for attending conference from various companies. Another author disclosed receiving personal fees from various pharmaceutical companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.