Patients with MASH experience worse health-related quality of life: a multinational real-world study using LiverMultiScan
In brief
High-risk MASH patients reported up to 12% more quality-of-life complaints
In a four-country study of 802 people with suspected fatty liver disease, those whose MRI results indicated MASH reported worse quality of life than those with MASLD, even after adjustment for metabolic conditions. High-risk MASH was linked to up to 12% more complaints across quality-of-life dimensions, but COVID-related gaps in 12-month follow-up limit comparisons over time.
- Journal
- Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation (Q1)
- Published
- 22 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Elizabeth Shumbayawonda, Megh Utsav, Marika Hancock, Alexander Thompson, Dimitar Tonev, Stephen Barclay, et al.
- PMID
- 42911297
- DOI
- 10.1007/s11136-026-04420-8
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 25 October 2026): Clinical associations of quantitative liver MRI biomarkers
Abstract
PURPOSE: Prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), is increasing globally. Assessment of health-related quality of life (HRQoL), alongside non-invasive tests (NITs), may support identification of patients requiring closer clinical management. This multinational real-world randomised controlled trial evaluated associations between HRQoL (using the EQ-5D) and multiparametric MRI (mpMRI) markers of liver disease. METHODS: RADIcAL-1 included 802 patients (453 male) with suspected MASLD/MASH from Germany, Netherlands, Portugal and UK. Participants completed the EQ-5D-5 L at baseline, 2, 6 and 12-months. EQ-VAS was derived to assess overall health. Between-group comparisons (imaging vs. standard-of-care) were assessed using t-tests, and multivariable logistic regression adjusted for age, obesity, diabetes and hyperlipidaemia. MASH was defined as corrected T1 (cT1) ≥800ms and liver fat as proton density fat fraction (PDFF) ≥ 10%. High-risk MASH was cT1 ≥ 875ms. RESULTS: Within the imaging arm, patients with MASH reported lower HRQoL across all EQ-5D dimensions and EQ-VAS compared with MASLD. Baseline utilities ranged from 0.81 (Coimbra) to 0.90 (Ulm) and this range decreased at month 12 from 0.82 (Coimbra and UK) to 0.90 (Ulm). These findings remained after adjustment for comorbidities. Patients with high-risk MASH reported up to 12% more complaints in all EQ-5D dimensions compared to all others. Increasing cT1 was associated with 29% higher odds of reporting anxiety/depression. An 80ms increase in cT1 was associated with 0.023-point decrease in EQ-5D utility (p = 0.039). Due to COVID-19, 12-month response rates varied across sites (22-81%). CONCLUSION: mpMRI-defined MASH is associated with worse HRQoL independent of key metabolic comorbidities. These findings support the use of imaging biomarkers for disease stratification and for identifying patients with greater clinical burden, with potential implications for management and monitoring strategies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.