Improving cervical cancer screening uptake through theory-informed education: a comprehensive systematic review and meta-analysis.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is increasingly recognised as a hepatic manifestation of metabolic dysfunction and is one of the most prevalent chronic liver conditions worldwide. MASLD affects an estimated 25–30% of the adult population, with its rising prevalence linked to the growing burden of obesity, insulin resistance, and type 2 diabetes mellitus []. While previous studies have primarily focused on the association between MASLD and cardiovascular disease, liver-related events, and all-cause mortality [], accumulating evidence suggests that MASLD may also be linked to psychological comorbidities, particularly depression and anxiety []. These conditions are well-established risk factors for suicide, a critical global public health issue. However, there is currently no direct evidence linking MASLD to suicide mortality, highlighting a significant gap in the literature. Emerging evidence suggests that individuals with chronic liver disease are at an elevated risk for suicide []. It is therefore essential to determine whether MASLD has similar vulnerabilities, especially considering its silent clinical course and the underdiagnosis in its early stages. Furthermore, the revised nomenclature for fatty liver disease introduces an important conceptual advancement by recognising a distinct diagnostic category: metabolic dysfunction–associated alcohol-related liver disease (MetALD) []. This reclassification allows for subtype-specific risk assessments by identifying individuals with overlapping metabolic dysfunction and alcohol exposure, rather than viewing fatty liver disease as a single entity. This category encompasses individuals with metabolic dysfunction who consume 30–60 g/day (210–420 g/week) of alcohol for men and 20–50 g/day (140–350 g/week) for women, exceeding the thresholds set for MASLD. Since these subtypes may exhibit distinct clinical trajectories and underlying mechanisms, it is crucial to differentiate between them for an accurate assessment of their respective risks. Given the unique metabolic and clinical characteristics of MetALD, the suicide risk profile in this population may also differ from that of MASLD or conventional alcohol-associated liver disease (ALD). However, this population remains largely underexplored. Therefore, in this nationwide population-based cohort study, we aimed to evaluate the long-term risk of suicide mortality among individuals with MASLD, MetALD, and ALD, compared to those without steatotic liver disease (SLD). By clarifying these associations, our study may help identify vulnerable subgroups and inform future screening and intervention strategies for suicide prevention among patients with chronic liver disease. This study used data from the Korean National Health Insurance Service (NHIS), a government-managed system that covers almost the entire population of Korea. The NHIS database includes a variety of health-related information, such as demographic details, physical examination results, laboratory findings, lifestyle factors, diagnostic codes from the International Classification of Diseases, 10th Revision (ICD-10), and treatment records. Mortality outcomes were determined by linking de-identified participant data from the NHIS with national death registry records maintained by Statistics Korea. The study adhered to the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of The Catholic University of Korea (IRB No. SC24ZISE0043). The requirement for informed consent was waived due to the retrospective nature of the study. This study was conducted in accordance with the STROBE reporting guidelines.