Occupational exposure and risk of complications in MASLD patients:updates from a case:control study

Introduction

Pollutants are increasingly being evaluated as possible contributors to the progression of liver damage in metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, we published a case-control study showing that patients with MASLD-related advanced chronic liver disease (ACLD) and/or hepatocellular carcinoma (HCC) were more likely to report workplace toxicant exposure compared to those with uncomplicated MASLD. Consequently, an extension of the accrual and a transition to a multicenter study were decided.

Aim

To provide updated evidence following the first extension of the cohort from our original study, which aimed to assess the prevalence of self-reported occupational exposure to toxicants in patients with MASLD.

Methods

After the extension, this hospital-based prospective pilot study include 224 patients with MASLD. Data on workplace toxicant exposure were collected systematically using a structured questionnaire. Subsequently, patients with ACLD and/or HCC (n = 65) were compared to controls (n = 159). Logistic regression analysis and propensity score models were used to investigate the associations between self-reported occupational exposure and ACLD and/or HCC.

Results

The updated data confirmed that patients with ACLD/HCC are more likely to report exposure to metals, halogenated refrigerants, paint/resins, and fuel emissions than the controls. Durations of 21-30 years and >30 years of occupational exposure to toxicants were also more frequently associated with ACLD/HCC, with odds ratios (ORs) of 2.42 (95% confidence interval [CI]: 1.11-4.94, p = 0.020) and 4.21 (95% CI: 2.36-7.53, p < 0.001), respectively. These associations were confirmed after corrections for demographics and other confounders.

Conclusions

The extension of our cohort confirms that patients with MASLD complications are more likely to report workplace toxicant exposure than controls. A transition to a multicenter effort is underway. If confirmed, our results may help in developing prevention policies to reduce the risk of life-threatening diseases among exposed populations.