The liver provides vital functions on which metabolic balance, detoxification or digestion depend. However, this essential organ often remains neglected, until the day when its mechanisms are afraid. Among the silent pathologies that threaten it, the MASLD progresses at low noise and now affects a considerable part of the world's population.
What makes this disease particularly worrying are its possible complications. In the absence of treatment, it can evolve towards serious forms. It can cause fibrosis, cirrhosis or liver failure. In some cases, the heart or kidneys can also be affected. A study by the University of South California, published in September 2025, confirmed this threat. Released in Clinical Gastroenterology and Hepatology, it underlines how this danger has been underestimated so far.
The analysis is based on health data of more than 130,000 adults collected between 1988 and 2018 as part of the Nhanes program. On this sample, around 21,000 people met the clinical criteria of the Masld. This vast epidemiological follow -up made it possible to identify the factors associated with an increased risk of mortality in patients concerned.
Masld reveals his hidden risks for the heart and the kidneys
The results of the study highlighted an unexpected reality. Among the multiple cardiometabolic factors associated with the MASLD, three in particular prove to be linked to a much higher risk of death than the others. Hypertension leads, with an increase in the risk of mortality estimated at 40%. Then come diabetes or prediabetes, responsible for an increase of 25%, then low HDL rates, often nicknamed “good cholesterol”, which increase the risk by 15%.
These figures surprised the researchers, who until then thought that diabetes was the main threat to liver patients. Matthew Dukewich, hepatologist at the USC and the first author of the study, stresses that this risk hierarchy calls into question certain clinical priorities.
In an interview published by Keck Medicine of USC, Professor Norah A. Terrault insists on the interest of these results to orient care. According to her, identifying the markers most strongly associated with mortality makes it possible to target medical interventions in a more efficient and personalized manner.
The study also highlights a worrying fact. Each additional cardiometabolic risk factor increases the risk of death by 15%. This gradual increase stresses how the disease is based on a global imbalance. It does not result from an isolated element, but from a sequence of metabolic disorders that strengthen each other.
The three factors to target in priority to reduce mortality
High blood pressure, long relegated to the background in the management strategies of the MASLD, is therefore found today at the center of concerns. For researchers from the study relayed by Scitechdaily, this discovery could justify a revision of care protocols, giving a priority place to the control of blood pressure.
The role of HDL, although often mentioned in cardiovascular prevention, is also decisive in the evolution of liver disease. A low rate of this protective cholesterol seems to promote the inflammatory mechanisms that cause many complications.
Finally, obesity – the most frequently observed factor in patients – can no longer be considered as a simple general indicator of poor health. The study reveals a clear correlation between the increase in the body mass index (BMI) and mortality, in particular for BMIs greater than 35. This dose-dependent link suggests that the reduction in body weight could, by itself, significantly improve the chances of survival.
As Bioengineer points out, study authors argue for a global approach to treatment. It is no longer a question of acting on a single lever, but rather of combining actions on all metabolic factors. This integrated vision could change the situation for the millions of patients concerned by the MASLD, finally by proposing a prevention strategy adapted to the complexity of the disease.
