Poor Diet, Social Determinants of Health Linked to Fibrosis, HRQoL in MASLD

Cardiometabolic risk factors, physical activity, diet, and social determinants of health are associated with health-related quality of life (HRQoL) and fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), according to findings from a recent study.1

The cross-sectional analysis included a prospectively enrolled cohort of patients with MASLD and found living in a more impoverished neighborhood, dyslipidemia, obesity, and physical inactivity were associated with HRQoL, while decreased physical activity, poorer diet, neighborhood-level poverty, and lower HRQoL were associated with cirrhosis.1

The most common chronic liver disease in the world, MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), is estimated to affect more than 30% of the global population and is a leading cause of end-stage liver disease.2 While it is widely regarded as being linked to cardiometabolic risk factors, MASLD’s association with behavioral risk factors is less recognized.

“While there is existing literature regarding HRQoL in patients with MASLD, many of these studies have not considered the association of a combination of lifestyle factors such as exercise and diet, or social determinants of health, with HRQoL in patients with MASLD, or the associations of multiple lifestyle factors with fibrosis,” Vincent Chen, MD, an assistant professor at University of Michigan Health, and colleagues wrote.1

To address this gap in research, investigators conducted a cross-sectional analysis of prospective patients with MASLD seen in a hepatology clinic at the University of Michigan from March 2021 through January 2024. For inclusion, patients were required to have objective evidence of hepatic steatosis on imaging or liver biopsy; historical evidence of steatosis in patients with cirrhosis at time of enrollment; and ≥ 1 MASLD cardiometabolic criterion.1

Participants completed validated surveys on HRQoL, diet, and physical activity, and a subset also underwent vibration controlled transient elastography (VCTE). Investigators also obtained data from electronic medical records for laboratory values, medical diagnoses, and VCTE results. The primary outcomes were HRQoL measured by Short Form-8 and cirrhosis.1

In total, the study included 304 participants. Among the cohort, the median age was 59.5 (interquartile range, 50–67) years, 54% of patients were female, and 22% had cirrhosis.1

Investigators noted the majority of participants had a FIB-4 score < 1.3 and LSM < 8 kPa, additionally calling attention to a high prevalence of cardiometabolic comorbidities including type 2 diabetes (38%), hypertension (45%), and dyslipidemia (42%).1

Upon analysis, cardiometabolic comorbidities were associated with lower overall HRQoL scores, including higher body mass index (− 0.6 per BMI point; 95% confidence interval [CI], -1.0 to -0.2); hypertension (− 4.5; 95% CI, -8.9 to -0.2), diabetes (− 7.3; 95% CI, − 11.6 to − 2.9), and cardiovascular disease (− 14.8; 95% CI, -23.2 to -6.4) (all P <.05).1

Investigators additionally pointed out the presence of cirrhosis and LSM ≥ 8 kPa were associated with lower SF8, with effect size of − 7.5 (95% CI, -12.6 to -2.4) for cirrhosis and -8.0 (95% CI, -13.0 to -3.0) for LSM ≥ 8 kPa.1

Social determinants of health were also associated with HRQoL. Each decile increase in state-level rank in Area Deprivation Index (ADI) was associated with lower HRQOL (-2.2; 95% CI, -3.4 to -1.4; P <.001). Similarly, higher neighborhood disadvantage score was associated with lower HRQoL (-4.4; 95% CI, -6.3 to -2.5; P <.001) whereas higher neighborhood affluence was associated with higher HRQoL (5.2; 95% CI, 3.3 to 7.0; P <.001). Investigators pointed out these findings remained significant in adjusted models.1

In univariable analysis, factors associated with cirrhosis included increasing age (per-year odds ratio [OR], 1.1; 95% CI, 1.0 to 1.1; P <.001) and diabetes (OR, 4.0; 95% CI, 2.2 to 7.0; P <.001). Additionally, higher affluence score was associated with lower prevalence of cirrhosis (per-quartile OR, 0.6; 95% CI, 0.5 to 0.8; P <.001), and greater disadvantage (per-quartile OR, 1.4; 95% CI, 1.1 to 1.9; P = .008) and state-level rank in ADI (per decile OR, 1.2; 95% CI, 1.1 to 1.3; P = .001) were associated with greater prevalence of cirrhosis.1

After adjustment for age, sex, and race, BMI, diabetes, higher ADI scores and greater disadvantage remained significantly associated with a higher prevalence of cirrhosis, while adequate exercise, greater intake of vegetables, and affluence remained associated with a lower prevalence of cirrhosis.1

“Future studies will assess the impact of lifestyle factors on longitudinal outcomes in conjunction with blood-based biomarkers derived from the cohort,” investigators concluded.1

References

1. Czapla BC, Dalvi A, Hu J, et al. Physical activity, diet, and social determinants of health associate with health related quality of life and fibrosis in MASLD. Scientific Reports. https://doi.org/10.1038/s41598-025-93082-6

2. AASLD. New MASLD Nomenclature. Accessed March 11, 2025. https://www.aasld.org/new-masld-nomenclature