Metabolic associated fatty liver disease better identifying patients at risk of liver and cardiovascular complications (original) (raw)

Abstract

Background/purpose

A nomenclature of “metabolic associated fatty liver disease” (MAFLD) with a new definition was proposed in 2020 instead of the previous “non-alcoholic fatty liver disease” (NAFLD). Whether it better coheres with the clinical demand remains controversial.

Methods

The participants with fatty liver on ultrasonography in Taiwan bio-bank cohorts were included. MAFLD is defined as the presence of fatty liver, plus any of the following three conditions: overweight/obesity, type 2 diabetes mellitus (DM), or metabolic dysfunction. The severity of liver fibrosis was determined using fibrosis-4 (FIB-4) index and NAFLD fibrosis score (NFS). The risk of atherosclerotic cardiovascular disease was assessed using intima–media thickness (IMT) or plaques of carotid duplex ultrasound.

Results

A total of 9,719 subjects (ages 55.9 ± 10.8; males 42.6%) were distributed among 4 groups: “overlapping group”, “MAFLD only”, “NAFLD only”, and “neither fatty liver disease (FLD)” with the percentages of 79.7, 12, 7.1, and 1.2%, respectively. Compared with NAFLD patients, MAFLD patients had a greater percentage of males, higher levels of BMI, waist circumference, HbA1c, and triglyceride. In addition, they had higher levels of serum ALT, AST, GGT, fatty liver index (FLI), NFS, and IMT, but no difference in FIB-4 index and the percentage of carotid plaques. To note, “MAFLD only group” had greater levels of AST, ALT, GGT, FLI, FIB-4, NFS, IMT and a higher percentage of carotid plaques than the “NAFLD only group”.

Conclusion

The grand, population-based study showed MAFLD with new diagnostic criteria to aid in identifying a greater number of high-risk patients of metabolic, liver, and cardiovascular complications, suggesting MAFLD may be a better nomenclature than NAFLD in clinical practice.

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Funding

This work was supported by grants from Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (TCRD-TPE-111–09) and the Taiwan Liver Disease Consortium, Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-091-MY3).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tung’s Taichung MetroHarbor Hospital, Taichung, Taiwan
    Yu-Ming Cheng
  2. Department of Gastroenterology, Buddhist Tzu Chi Medical Foundation and School of Medicine, Taipei Tzu Chi Hospital, Tzu Chi University, Hualien, Taiwan
    Chia-Chi Wang
  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    Jia-Horng Kao
  4. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
    Jia-Horng Kao
  5. Medical Department, Buddhist Tzu Chi Medical Foundation and School of Medicine, Taipei Tzu Chi Hospital, Tzu Chi University, 289 Jianguo Rd., Xindian Area, New Taipei City, 23142, Taiwan
    Chia-Chi Wang

Authors

  1. Yu-Ming Cheng
  2. Chia-Chi Wang
  3. Jia-Horng Kao

Corresponding author

Correspondence toChia-Chi Wang.

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Conflict of interest

Yu-Ming Cheng, Chia-Chi Wang, and Jia-Horng Kao declare no conflict and interest.

Ethical considerations

This study was performed in accordance with the principles of the 1975 Declaration of Helsinki and approved by the Research Ethics Committee of Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation (approval numbers: 10-XD-055 and 11-X-074) with waived informed consent and the Ethics and Governance Council of the TWB (approval numbers: TWBR11102-03).

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Cheng, YM., Wang, CC. & Kao, JH. Metabolic associated fatty liver disease better identifying patients at risk of liver and cardiovascular complications.Hepatol Int 17, 350–356 (2023). https://doi.org/10.1007/s12072-022-10449-x

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