Journal of Korean Medical Science · Apr 6, 2026

Incidence of Metabolic Dysfunction-Associated Steatotic Liver Disease After Developing Depression: A Population-Based Cohort Study

By Kim E, Sohn W, Kim YT et al.

BACKGROUND: As a significant public health issue, research on metabolic dysfunction-associated steatotic liver disease (MASLD) has increased; however, studies exploring the relationship between MASLD and depression are scarce. Thus, our objective was to examine the impact of depression on the subsequent risk of developing MASLD in a large cohort of Korean adults and to investigate the stratification of this association by sex and menopausal status. METHODS: We utilized a large-scale, population-based cohort study in South Korea, specifically the Kangbuk Samsung Health Study. Hepatic steatosis was diagnosed using ultrasonography. Depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression (CES-D) score, and participants were categorized into no-depression (CES-D < 8, reference), sub-threshold depression (CES-D: 8-15), and depression (CES-D ≥ 16). Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Several interaction and stratification analyses were performed based on sex, age, and menopausal status. RESULTS: During the 1,016,691.99 person-years of follow-up, 170,981 Korean adults (men, 71,796 [42.0%]; women, 99,185 [58.0%]) were followed for a median of 5.4 years (maximum, 12.9 years). In total, 41,932 (24.5%) individuals with incident MASLD were identified. Compared with CES-D < 8, the aHRs (95% CIs) for incident MASLD were 1.03 (1.00-1.06; P = 0.045) for CES-D: 8-15 and 1.06 (1.01-1.11; P = 0.011) for CES-D ≥ 16 in men, and 1.05 (1.01-1.09; P = 0.027) for CES-D: 8-15 and 1.18 (1.13-1.24; P < 0.001) for CES-D ≥ 16 in women (P for interaction = 0.007). In women aged < 45, the risk of developing MASLD increased linearly with higher CES-D scores, indicating a positive association between depressive symptoms and MASLD incidence. CONCLUSION: Depression was associated with an increased risk of MASLD in both sexes and acted as a potential independent risk factor, particularly in women aged < 45. These findings suggest that screening for MASLD should be considered in younger women with depression.

doi.org/10.3346/jkms.2026.41.e6Open accessPubMed 41943259Populations