Background & Aims Metabolic Associated Fatty Liver Disease (MAFLD) was proposed as a better definition of Non-Alcoholic Fatty Liver Disease (NAFLD) to encompass the metabolic dysregulation associated with NAFLD. This redefinition challenges our understanding of the disease. Hence, this study sought to conduct an updated analysis of the prevalence, clinical characteristics and associated factors of MAFLD, with a further sensitivity analysis done based on lean and non-obese MAFLD individuals. Methods Medline and Embase databases were searched to include articles on MAFLD. Meta-analysis of proportions was conducted using the generalised linear mix model. Associating factors were evaluated in conventional pairwise meta-analysis with sensitivity analysis on lean and non-obese MAFLD. Results From pooled analysis involving 3,320,108 individuals, the overall prevalence of MAFLD was 38.77% (95%CI: 32.94% to 44.95%). 5.37% (95%CI: 4.36% to 6.59%) and 29.78% (95%CI: 26.06% to 33.79%) being of lean and non-obese respectively had MAFLD. Metabolic complications such as hypertension (OR: 2.63; 95%CI: 1.85 to 3.74; p<0.0001 and OR: 2.03; 95%CI: 1.74 to 2.38; p<0.0001, respectively) and diabetes (OR: 3.80; 95%CI: 2.65 to 5.43; p<0.0001 and OR: 3.46; 95%CI: 2.81 to 4.27; p<0.0001, respectively) were found as significant associating factors associated with lean and non-obese MAFLD. Conclusions This meta-analysis supports previous studies in reporting MAFLD to affect more than a third of the global population. While exploration of the pathogenic basis of fatty liver disease without metabolic dysregulation is required, the emphasis on management of concomitant metabolic disease in MAFLD can improve multidisciplinary efforts in managing the complex disease.

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Background & Aims:Non-Alcoholic Fatty Liver Disease (NAFLD) is associated with the development of cardiovascular disease. While existing studies have examined cardiac remodeling in NAFLD, there has been less emphasis on the development of carotid atherosclerosis and stroke. We sought to conduct a metaanalysis to quantify the prevalence, risk factors and degree of risk increment of carotid atherosclerosis and stroke in NAFLD. Methods:Embase and Medline were searched for articles relating to NAFLD, carotid atherosclerosis, and stroke.Proportional data was analysed using a generalized linear mixed model. Pairwise meta-analysis was conducted to obtain odds ratio or weighted mean difference for comparison between patients with and without NAFLD. Results:From pooled analysis of 30 studies involving 7,951 patients with NAFLD, 35.02% (95%CI: 27.36% to 43.53%) had carotid atherosclerosis with an odds ratio of 3.20 (95%CI: 2.37 to 4.32; p<0.0001).Pooled analysis of 25,839 patients with NAFLD found the prevalence of stroke to be 5.04% (95%CI: 2.74% to 9.09%) with an odds ratio of 1.88 (95%CI: 1.23 to 2.88; p=0.02) compared to non-NAFLD.The degree of steatosis assessed by ultrasonography in NAFLD was closely associated with increment in odds of carotid atherosclerosis and stroke. Older age significantly increased the odds of developing carotid atherosclerosis but not stroke in NAFLD. Conclusions:This meta-analysis shows that a stepwise increment of steatosis of NAFLD can significantly increase the odds of carotid atherosclerosis and stroke development in NAFLD. More than a third suffer from carotid atherosclerosis and routine assessment of carotid atherosclerosis is quintessential in NAFLD.

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Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals.Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk.Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality.Conclusions: Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.

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Non-alcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide. The estimated global incidence of NAFLD is 47 cases per 1000 population and is higher among males compared to females. The estimated global prevalence of NAFLD among adults is 32% and is higher among males (40%) compared to females (26%). The global prevalence of NAFLD has increased over time, from 26% in studies from 2005 or earlier to 38% in studies from 2016 or beyond. The prevalence of NAFLD varies substantially by world region, contributed by differing rates of obesity, and genetic and socioeconomic factors. The prevalence of NAFLD exceeds 40% in the Americas and South-East Asia. The prevalence of NAFLD is projected to increase significantly in multiple world regions by 2030 if current trends are left unchecked. In this review, we discuss trends in the global incidence and prevalence of NAFLD and discuss future projections.

Background and Aims: Fatty liver is the commonest liver condition globally and traditionally associated with NAFLD. A consensus meeting was held in Chicago to explore various terminologies. Herein, we explore the proposed changes in nomenclature in a population data set from the US.Approach and Results: Statistical analysis was conducted using surveyweighted analysis. Assessment of fatty liver was conducted with vibrationcontrolled transient elastography. A controlled attenuation parameter of 288 dB/m was used to identify hepatic steatosis. Patients were classified into nonalcoholic steatotic liver disease, alcohol-associated steatotic liver disease, and viral hepatitis steatotic liver disease. Liver stiffness measures at ≥ 8.8, ≥ 11.7, and ≥ 14 kPa were used to identify clinically significant fibrosis, advanced fibrosis, and cirrhosis, respectively. A total of 5102 individuals were included in the analysis. Using a survey-weighted analysis, a total of 25.43%, 6.95%, and 0.73% of the population were classified as nonalcoholic steatotic liver disease, alcohol-associated steatotic liver disease, and viral hepatitis steatotic liver disease, respectively. A sensitivity analysis at controlled attenuation parameter of 248 dB/m and fatty liver index found similar distribution. In a comparison between nonalcoholic steatotic liver disease, alcohol-associated steatotic liver disease, and viral hepatitis steatotic liver disease, there was no significant difference between the odds of advanced fibrosis and cirrhosis between groups.However, viral hepatitis steatotic liver disease individuals were found to