代谢功能障碍相关的脂肪变性肝病(MASLD)已成为全球最常见的慢性肝病,并且越来越多地在年轻时被诊断出来。影响了超过三分之一的肥胖年轻人。
■评估围产期状况与MASLD风险和相关进行性肝病之间的关联。
■这个全国性的,基于人群的病例对照研究纳入了瑞典所有经活检证实的MASLD病例.25岁或以下的个人(以下,1992年1月1日至2016年12月31日期间经活检证实的MASLD的年轻个体)与多达5名普通人群对照个体相匹配。从瑞典医学出生登记册中检索了有关孕产妇和围产期特征的颗粒数据。数据从2023年6月到2024年6月进行了分析。
■出生体重(低[<2500g],参考[2500至<4000g],或高[≥4000g]),胎龄(GA),和GA的出生体重(GA小[SGA;<10%],适用于GA[10-90百分位数],或大的GA[LGA;>90百分位数]),患者和配对对照之间的比较。
■主要结果是活检证实的MASLD和MASLD相关的进行性肝病的几率(即,肝纤维化或肝硬化)根据出生体重,GA,GA的出生体重,根据匹配因素进行调整。
■总共,165例经活检证实的MASLD的年轻人(诊断时的中位年龄:12.0岁[IQR,4.4-16.9岁];100[60.6%]男性)与717名对照相匹配。低出生体重与MASLD的未来发展之间存在关联(调整后的优势比[AOR],4.05;95%CI,1.85-8.88),但高出生体重与MASLD几率无关联(AOR,0.64;95%CI,0.38-1.08)与参考出生体重相比。SGA(AOR,3.36;95%CI,2.00-5.64)与GA(参考类别)但LGA(AOR,0.57;95%CI,0.27-1.20)。进行性肝病在低出生体重的个体中更常见(AOR,6.03;95%CI,1.66-21.87)或SGA(AOR,4.90;95%CI,2.15-11.14)。
■在这项全国范围内对具有活检证实的MASLD的年轻人进行的研究中,低出生体重和SGA与MASLD和进行性肝病的发展有关,提示有必要采取结构化筛查措施,以便在高危人群中早期诊断这些疾病.
UNASSIGNED: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide and is increasingly being diagnosed at younger ages, affecting more than one-third of young people with obesity.
UNASSIGNED: To evaluate associations between perinatal conditions and risk of MASLD and associated progressive liver disease.
UNASSIGNED: This nationwide, population-based case-control study included all biopsy-confirmed cases of MASLD in Sweden. Individuals aged 25 years or younger (hereafter, young individuals) with biopsy-proven MASLD between January 1, 1992, and December 31, 2016, were matched to up to 5 general population control individuals. Granular data on maternal and perinatal characteristics were retrieved from the Swedish Medical Birth Register. Data were analyzed from June 2023 to June 2024.
UNASSIGNED: Birth weight (low [<2500 g], reference [2500 to <4000 g], or high [≥4000 g]), gestational age (GA), and birth weight for GA (small for GA [SGA; <10th percentile], appropriate for GA [10th-90th percentile], or large for GA [LGA; >90th percentile]), compared between patients and matched controls.
UNASSIGNED: The main outcome was odds of biopsy-proven MASLD and MASLD-associated progressive liver disease (ie, liver fibrosis or cirrhosis) according to birth weight, GA, and birth weight for GA, adjusted for matching factors.
UNASSIGNED: In total, 165 young individuals with biopsy-proven MASLD (median age at diagnosis: 12.0 years [IQR, 4.4-16.9 years]; 100 [60.6%] male) were matched with 717 controls. There was an association between low birth weight and future development of MASLD (adjusted odds ratio [AOR], 4.05; 95% CI, 1.85-8.88) but no association between high birth weight and odds of MASLD (AOR, 0.64; 95% CI, 0.38-1.08) compared with the reference birth weight. An association was seen for SGA (AOR, 3.36; 95% CI, 2.00-5.64) compared with appropriate size for GA (reference category) but not for LGA (AOR, 0.57; 95% CI, 0.27-1.20). Progressive liver disease was more common in individuals born with low birth weight (AOR, 6.03; 95% CI, 1.66-21.87) or SGA (AOR, 4.90; 95% CI, 2.15-11.14).
UNASSIGNED: In this nationwide study of young individuals with biopsy-proven MASLD, low birth weight and SGA were associated with development of MASLD and progressive liver disease, suggesting a need for structured screening measures to diagnose these conditions early in high-risk individuals.