In a groundbreaking study presented at UEG Week 2023, a significant link has been unveiled between birth weight and the development of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease.
A team of Swedish researchers utilized the nationwide ESPRESSO cohort to conduct a population-based case-control study. The study involved individuals aged 25 years and younger who had received a diagnosis of biopsy-proven MASLD between January 1992 and April 2017, totaling 165 cases. To minimize confounding factors, each MASLD-affected individual was meticulously matched with up to five controls from the general population based on age, sex, calendar year, and county of residence.
Low Birth weight’s Striking Impact on MASLD
The study revealed a striking correlation between low birth weight (<2500 g/5 lbs 8 oz) and the development of MASLD. Babies born with low birth weight were found to be four times more likely to develop fatty liver compared to those with normal birth weight. Additionally, those born as small for gestational age (SGA), falling below the 10th percentile, were over three times more likely to develop MASLD in their early years compared to those with an adequate birth weight (10th–90th percentile).
Higher Risk of Severe MASLD Stages for Low Birthweight Individuals
Intriguingly, individuals born with low birthweight or those born as SGA faced a significantly higher relative risk of developing more severe stages of MASLD, such as liver fibrosis or cirrhosis. The risk for these individuals was up to approximately six times greater.
Foetal Developmental Factors in the Spotlight
Dr. Fahim Ebrahimi, the study’s first author, emphasized that while previous research had established links between birth weight and major diseases like cardiovascular disease and metabolic syndrome, the connection to MASLD had remained unclear. The study now provides compelling evidence that foetal developmental factors play a significant role in the development of MASLD and progressive liver disease.
Growing Threat of MASLD in an Obese World
Amidst the rising rates of obesity, MASLD has become the most prevalent cause of chronic liver disease globally. In Europe, it is estimated to affect over 25% of adults, with its prevalence increasing among obese or overweight young people. Moreover, it has emerged as one of the fastest-growing causes of end-stage liver disease, primary liver cancer, and liver transplantation, albeit affecting only a few individuals who experience its progression.
Future Directions: Early Screening and Intervention
Dr. Ebrahimi concludes by highlighting the need for further research to comprehend the underlying immunological and metabolic mechanisms. Several studies suggest that both overnutrition and undernutrition during pregnancy can lead to lasting epigenetic changes that affect an individual’s metabolism throughout their lifetime. It is now crucial to develop proactive and effective strategies, such as early and targeted screening, to identify at-risk individuals and mitigate the burden of this disease.