Young Adults Are at Highest Risk of Liver Fibrosis and Mortality Associated With Steatotic Liver Disease With Metabolic Dysfunction and Alcohol Consumption
Bibliographic record
Abstract
BACKGROUND: Alcohol consumption in patients with steatotic liver disease (SLD) with metabolic dysfunction (MD) increases the risk of liver fibrosis and mortality. However, whether these risks vary by age remains poorly understood. METHODS: Data from NHANES-III were used, including participants with data on SLD, alcohol consumption, and mortality. SLD was determined using ultrasonography, MD was defined according to the guidelines as ≥ 1 metabolic risk factor, and mild-to-moderate alcohol consumption as 10-50 g/day (females) or 20-60 g/day (males). Mortality data were obtained from the National Death Index until December 31, 2015. The impact of SLD with MD and alcohol consumption on mortality was evaluated using multivariable Cox regression, including age (categorized as 20-< 40, 40-< 60, and 60-< 80 years) as an interaction term, and adjusted for demographic and cardiometabolic factors. The risk of fibrosis was determined using two distinct, validated, non-invasive tests: the Metabolic Dysfunction Associated Fibrosis-5 (MAF-5) score and the Fibrotic NASH Index (FNI). RESULTS: We included 13,062 participants (aged 20-< 40: 3097; 40-< 60: 3960; 60-< 80: 3008). SLD with MD was present in 31% (20-< 40: 23%; 40-< 60: 28%; 60-< 80: 41%), and 11% reported mild-to-moderate alcohol use (mean intake: 5.4 g/day, 6.2 g/day, and 3.7 g/day, respectively). Over a median follow-up of 23 years, 30% of participants died. Both SLD with MD (aHR: 1.29, 95% CI: 1.01-1.65) and alcohol consumption (aHR: 1.63, 95% CI: 1.21-2.19) were associated with increased all-cause mortality. Significant interactions with age were observed for SLD with MD (p = 0.037) and alcohol use (p < 0.001), with younger adults experiencing highest relative mortality risks. A similar age-dependence was seen for fibrosis risk. CONCLUSIONS: Young adults face the highest fibrosis and mortality risk associated with SLD with MD and alcohol consumption, likely reflecting years lived with these risk factors. Our findings highlight the need to prioritize lifestyle interventions in younger adults to prevent fibrosis and premature mortality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".