Clinical characteristics associated with stimulant consumption of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) in Germany – Data from the German SLD-Registry

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects more than 18 million individuals in Germany. Consumption of stimulants including alcohol, coffee and smoking is frequent among these patients but prospective data on the combinatorial effects are rare. Real-world data help to better characterize the natural history of disease and to guide targeted lifestyle intervention.

Methods: The German SLD-Registry is a prospective non-interventional study initiated by the German Liver Foundation aiming to describe clinical characteristics and observe outcomes in patients with SLD recruited in secondary and tertiary care. Detailed data on alcohol and coffee consumption as well as smoking are prospectively collected.

Results: From this ongoing study, baseline data of 903 patients were analysed. 40% (363/903) reported alcohol consumption (mean 1.4 g/day, 60% male). The alcohol subgroup had higher levels of ferritin (152 vs. 205 ng/ml) but less frequently high-risk fibrosis scores (FIB-4 >2.67 8.5 vs. 15%; NFS >0.675 9.3 vs. 17%) or liver stiffness (LS) values >9.6kPa (25 vs. 73%). Smokers (current 83/544, former 136/544) were more frequently male than never smokers (325/544) and had a trend towards higher CAP values (326 and 314 vs. 305dB in never smokers). No association of smoking to LS >9.6kPa or cirrhosis stage could be observed. Former smokers were characterised by more frequent CHD, hypercholesterolemia and hypertension. Coffee consumers (1-2 cups/day 229/464, 3-4 cups/day 117/464, >5 cups/day 36/464) more frequently had high-risk fibrosis scores compared to non-consumers (FIB-4 >2.67 17, 16, 14% vs. 9.8%; NFS >0.675 18, 13, 19 vs. 7.9%). LS >9.6kPa tended to be more frequent in non-consumers (45% vs. 36, 23 and 28%). CAP values were not different between these groups. Hypercholesterolemia was consistently more frequent among coffee drinkers. Overall, no association and additive or compensatory effects of alcohol, coffee consumption and smoking could be detected.

Conclusion: Data of the German SLD registry show that alcohol and coffee consumption are frequent among MASLD patients and both associated with advanced liver fibrosis as indicated by LS >9.6kPa. For smoking, no such association to fibrosis but a trend towards higher steatosis grade could be detected. Our data may confirm the beneficial effects of coffee and indicate that very low alcohol consumption may at least not exert relevant unfavorable effects of fibrosis progression.

Publication History

Article published online:
26 September 2024