Marked Variation in Hepatic Steatosis in Metabolic Dysfunction‐Associated Steatotic Liver Disease Over 5 Years: A Community‐Based Study Using Controlled Attenuation Parameter

Oct 8, 2025United European gastroenterology journal

Large Changes in Liver Fat Levels Over 5 Years in Metabolic-Related Fatty Liver Disease: A Community Study Using Fat Measurement Technology

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Abstract

Among 88 participants with steatosis at baseline, 34% experienced resolution of liver fat content over 5 years.

Liver fat content showed significant variability in a longitudinal study of 195 individuals.
Resolution of steatosis was linked to weight loss and decreases in certain liver enzymes.
29% of participants without steatosis at baseline developed liver fat during the follow-up period.
Increased liver stiffness measurements were associated with persistent steatosis but not with its resolution.
The findings highlight the dynamic nature of liver fat content in the general population.

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BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is very common and associated with significant morbidity and mortality due to its potential progression to cirrhosis and liver cancer. Whereas hepatic fat accumulation is the key to MASLD progression, little is known regarding changes in liver fat content over time in the general population. We aimed to investigate changes in liver fat in a longitudinal study of the general population.

METHODS: We conducted a longitudinal study involving 195 randomly selected individuals from the general population, evaluated at two time points, 5 years apart. Participants with at baseline did not receive any specific treatment. The primary objective was to assess changes in liver fat content, as estimated by controlled attenuation parameter (CAP) using transient elastography. We also examined the frequency of and development. CAP variability was assessed in two measurements 7 days apart in a cross-sectional study of 101 volunteers, with a mean variability of 9.9%. Steatosis resolution was defined as reduction of CAP > 10% from baseline with a final value < 275 dB/m, while was defined as increase in CAP > 10% with a final value ≥ 275 dB/m.

RESULTS: Remarkable variations in liver fat content were observed. Among the 88 participants with steatosis at baseline, 34% had resolution of steatosis (CAP decreased from 300 to 237 dB/m; p < 0.001). Resolution was associated with weight loss and reductions in transaminases and gamma-glutamyl transferase levels. In contrast, 29% of the 107 participants without steatosis at baseline developed it during follow-up. Increase in liver stiffness measurement (≥ 8 kPa) was associated only with persistent hepatic steatosis but not with steatosis resolution.

CONCLUSIONS: There is marked variation in liver fat content among participants from the general population over a period of 5 years, indicating its dynamic nature. These variations should be considered in epidemiological studies of MASLD.

Key numbers

30 of 88

Resolution of Steatosis

Participants with at baseline

31 of 107

Development of Steatosis

Participants without at baseline

63 dB/m

Change in CAP for Resolution

CAP values decreased from 300 to 237 dB/m

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Marked Variation in Hepatic Steatosis in Metabolic Dysfunction‐Associated Steatotic Liver Disease Over 5 Years: A Community‐Based Study Using Controlled Attenuation Parameter

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