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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.

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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