Association Between MASLD and Increased Risk of Serious Bacterial Infections Requiring Hospital Admission: Its Early Days

We would like to acknowledge the contribution of the meta-analysis conducted by Mantovani et al. [1], which substantiates the significant association between dysfunction-associated steatotic liver disease (MASLD) and an elevated risk of serious bacterial infections necessitating hospital admission. With shifts in lifestyle and dietary patterns, MASLD has emerged as the predominant liver disease, imposing a substantial social and economic burden globally [2]. MAFLD extends beyond hepatic implications, exhibiting close associations with cardiovascular, renal, orthopaedic, endocrine and oncological systems [3]. The association between infection and MASLD remains insufficiently explored in the existing literature. This article presents a rigorous investigation with a substantial sample size and is pioneering in performing a meta-analysis to examine the correlation between MASLD and the risk of severe bacterial infections. By synthesising data from eight studies, encompassing approximately 26 million individuals, the study elucidates the relationship between MASLD and the risk of severe bacterial infections necessitating hospital admission. The findings have generated considerable interest and warrant further inquiry. Nevertheless, the following points require in-depth exploration. Firstly, in figure 1, the author has combined analyses from cross-sectional and case–control studies within the meta-analysis, which could introduce potential bias into the results. Secondly, in the studies incorporated into this meta-analysis (references 18–21), a notable age disparity exists between the MASLD group and the non-MASLD group, with older patients exhibiting a higher propensity for developing severe infections in comparison with their younger counterparts [4, 5]. Consequently, the variability in baseline age may substantially influence the outcomes of the analysis. Finally, some studies included in this analysis contain duplicate patient data, such as those by (references 21 and 22), both derived from the Swedish Nationwide population-based cohort study with overlapping follow-up periods (1969 to 2017 vs. 1987 to 2020). This overlap contradicts the principles of literature inclusion for meta-analyses and may affect the results. We strongly concur with the author's significant findings in this article. Given that these factors above might influence the results, we enumerate them for the reference of readers. In conclusion, this meta-analysis has, for the first time, elucidated the significant association between MASLD and bacterial infections, thereby enhancing awareness of the risks linked with MASLD among researchers. Nonetheless, further large-sample, multi-centre and long-term follow-up cohort studies are necessary to substantiate these findings. Z.W., D.W., M.X., and Y.J. contributed substantially to the preparation of this paper. Z.W., D.W., M.X., and Y.J. have read and agreed to the published version of the manuscript. We acknowledge all authors' hard work. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.