Abstract：
OBJECTIVE: Few population-based studies have investigated the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and depression. Additionally, it remains unclear if depression affects progression to major adverse liver outcomes (MALO) in MASLD.
METHODS: All patients in Sweden with newly diagnosed MASLD between 2006 and 2020 were identified from the National Patient Register. Each patient was matched on age, sex, inclusion year, and municipality with up to 10 comparators from the general population. Cox regression was used to compare rates of severe depression in persons with MASLD to the comparators. In persons with MASLD, Cox regression was used to estimate rates of MALO using severe depression before baseline or diagnosed during follow-up as a time-varying exposure.
RESULTS: We included 11 301 persons with MASLD and 104 205 comparators who were followed for a median of 3.9 (IQR 1.5-7.6) and 4.9 years (IQR 2.3-8.7), respectively. The median age was 56 years and 5576 of 11 301 (49.3%) persons with MASLD were male. Incident severe depression developed in 228 of 11 301 (2.0%) persons with MASLD and 1160 of 104 205 (1.1%) comparators (fully adjusted hazard ratio [HR] = 1.8, 95% CI = 1.5-2.1). Of persons with MASLD, 25 of 1229 (2.0%) of those with severe depression before or after baseline progressed to MALO compared to 322 of 10 326 (3.1%) of those without severe depression (fully adjusted HR = 1.0, 95% CI = .6-1.5).
CONCLUSIONS: We confirm an association between MASLD and severe depression. However, no association between severe depression and incident MALO was found, but conclusions are limited by few observed outcomes.
METHODS: All patients in Sweden with newly diagnosed MASLD between 2006 and 2020 were identified from the National Patient Register. Each patient was matched on age, sex, inclusion year, and municipality with up to 10 comparators from the general population. Cox regression was used to compare rates of severe depression in persons with MASLD to the comparators. In persons with MASLD, Cox regression was used to estimate rates of MALO using severe depression before baseline or diagnosed during follow-up as a time-varying exposure.
RESULTS: We included 11 301 persons with MASLD and 104 205 comparators who were followed for a median of 3.9 (IQR 1.5-7.6) and 4.9 years (IQR 2.3-8.7), respectively. The median age was 56 years and 5576 of 11 301 (49.3%) persons with MASLD were male. Incident severe depression developed in 228 of 11 301 (2.0%) persons with MASLD and 1160 of 104 205 (1.1%) comparators (fully adjusted hazard ratio [HR] = 1.8, 95% CI = 1.5-2.1). Of persons with MASLD, 25 of 1229 (2.0%) of those with severe depression before or after baseline progressed to MALO compared to 322 of 10 326 (3.1%) of those without severe depression (fully adjusted HR = 1.0, 95% CI = .6-1.5).
CONCLUSIONS: We confirm an association between MASLD and severe depression. However, no association between severe depression and incident MALO was found, but conclusions are limited by few observed outcomes.
摘要：
目的：很少有基于人群的研究调查代谢功能障碍相关的脂肪变性肝病（MASLD）与抑郁症之间的关系。此外,目前尚不清楚抑郁症是否会影响MASLD中主要不良肝脏结局(MALO)的进展.
方法：瑞典2006年至2020年间新诊断为MASLD的所有患者均来自国家患者登记册。每个病人的年龄都是匹配的,性别,包含年份，和一般人口中最多有10个比较者的自治市。Cox回归用于将MASLD患者的严重抑郁症发生率与比较者进行比较。在拥有MASLD的人中，Cox回归用于估计MALO的发生率，在基线之前使用重度抑郁症或在随访期间诊断为随时间变化的暴露。
结果：我们包括11301名MASLD患者和104205名比较者，他们的随访中位数为3.9年（IQR1.5-7.6）和4.9年（IQR2.3-8.7），分别。中位年龄为56岁，11301名MASLD患者中有5576名（49.3％）为男性。11301名MASLD患者中有228名（2.0％）出现了严重抑郁症，104205名比较者中有1160名（1.1％）出现了严重抑郁症（完全调整的风险比[HR]=1.8，95％CI=1.5-2.1）。拥有MASLD的人，在基线之前或之后，1229例重度抑郁症患者中有25例（2.0％）进展为MALO，而在没有重度抑郁症的10326例中有322例（3.1％）（完全调整后的HR=1.0，95％CI=.6-1.5）。
结论：我们确认了MASLD与重度抑郁症之间的关联。然而,没有发现严重抑郁症和MALO事件之间的关联，但结论受到很少观察到的结果的限制。
方法：瑞典2006年至2020年间新诊断为MASLD的所有患者均来自国家患者登记册。每个病人的年龄都是匹配的,性别,包含年份，和一般人口中最多有10个比较者的自治市。Cox回归用于将MASLD患者的严重抑郁症发生率与比较者进行比较。在拥有MASLD的人中，Cox回归用于估计MALO的发生率，在基线之前使用重度抑郁症或在随访期间诊断为随时间变化的暴露。
结果：我们包括11301名MASLD患者和104205名比较者，他们的随访中位数为3.9年（IQR1.5-7.6）和4.9年（IQR2.3-8.7），分别。中位年龄为56岁，11301名MASLD患者中有5576名（49.3％）为男性。11301名MASLD患者中有228名（2.0％）出现了严重抑郁症，104205名比较者中有1160名（1.1％）出现了严重抑郁症（完全调整的风险比[HR]=1.8，95％CI=1.5-2.1）。拥有MASLD的人，在基线之前或之后，1229例重度抑郁症患者中有25例（2.0％）进展为MALO，而在没有重度抑郁症的10326例中有322例（3.1％）（完全调整后的HR=1.0，95％CI=.6-1.5）。
结论：我们确认了MASLD与重度抑郁症之间的关联。然而,没有发现严重抑郁症和MALO事件之间的关联，但结论受到很少观察到的结果的限制。
