Non-metabolic causes of steatotic liver disease

Abstract

Hepatic steatosis is caused by exaggerated hepatic lipid accumulation and is a common histological and radiological finding. Non-alcoholic fatty liver disease (NAFLD), or metabolic dysfunction associated steatotic liver disease (MASLD), is highly associated with metabolic syndrome and represents the most common cause of hepatic steatosis. However, since several comorbidities, lifestyle factors, and drugs can cause hepatic steatosis, MASLD is, to some extent, a diagnosis of exclusion. Nevertheless, initiatives have been taken to encompass positive (instead of negative) criteria for diagnosis - such as the presence of cardiometabolic risk factors together with hepatic steatosis. Nonetheless, before confirming a patient with MASLD, it is essential to map and evaluate other causes of fatty liver disease or steatotic liver disease. Several causes of hepatic steatosis have been identified in studies; however, the study cohorts are scarce and often anecdotal. Additionally, many studies have shown correlation without proving causation, and many are retrospective without reporting relevant patient characteristics and comorbidities - making it difficult to draw conclusions regarding the underlying etiology or present comorbidity of hepatic steatosis. In this narrative review, we aimed to identify and summarize present studies evaluating the impact of the most common and often suggested causes of hepatic steatosis.

Racial and ethnic disparities in metabolic dysfunction-associated steatotic liver disease

“…An important caveat is that previous studies identified patients according to the NAFLD definition. There is a significant overlap between NAFLD and MASLD, with both diagnoses requiring the presence of hepatic steatosis [7,8] . In MASLD, the presence of at least one cardiometabolic risk factor is required for the diagnosis [1] .…”

“…In MASLD, the presence of at least one cardiometabolic risk factor is required for the diagnosis [1] . Implementing this definition, a study investigated 1,333 patients at Swedish university hospitals with confirmed NAFLD and found that only 4 patients (0.3%) did not meet the criteria for a diagnosis of MASLD [7] . Similarly, utilizing proton-magnetic resonance spectroscopy, Song et al recently reported a minimal difference in the prevalence of NAFLD (25.6%) and MASLD (26.7%) in 1,106 random persons from Hong Kong [9] .…”

Exploring the role of testosterone upon adiposity and cardiovascular risk markers in men with severe obesity

“…Moreover, low testosterone levels in males have been linked with steatotic liver disease, independently of type 2 diabetes mellitus, insulin resistance, and BMI [39] .…”