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

Introduction: Pollutants are increasingly being evaluated as possi- ble 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 hep- atocellular 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 pi- lot study include 224 patients with MASLD. Data on workplace toxicant exposure were collected systematically using a struc- tured 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 refrig- erants, paint/resins, and fuel emissions than the controls. Dura- tions 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), respec- tively. These associations were confirmed after corrections for de- mographics 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 ef- fort is underway. If confirmed, our results may help in developing prevention policies to reduce the risk of life-threatening diseases among exposed populations.