Metabolic associated fatty liver disease better identifying patients at risk of liver and cardiovascular complications

Abstract

Background/purpose:A nomenclature of "metabolic associated fatty liver disease" (MAFLD) with new de nition was proposed in 2020 instead of previous "non-alcoholic fatty liver disease" (NAFLD). However, which better ts the clinical demand remains controversial. MethodsThe participants with fatty liver on ultrasonography from Taiwan bio-bank cohort were included. MAFLD was de ned 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 brosis was determined using brosis-4 (FIB-4) score and NAFLD brosis score (NFS). The risk of atherosclerosis was assessed using intima media thickness (IMT) or plaques of carotid duplex ultrasound. ResultsA total of 9719 subjects (age 55.9 ± 10.8; males 42.6%) were divided to four groups including "both fatty liver disease (FLD)", "MAFLD only", "NAFLD only", and "neither FLD" with the percentages of 79.7%, 12%, 7.1%, and 1.2%, respectively. Compared with NAFLD patients, MAFLD patients had higher frequency of male gender, BMI, waist circumference, HbA1C, and triglyceride. On 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. Of note, the added population "MAFLD only group" had higher levels of AST, ALT, GGT, FLI, FIB-4, NFS, IMT and higher percentage of carotid plaques than the missed population "NAFLD only group". ConclusionsThis large, population-based study showed MAFLD with new diagnostic criteria could identify more highrisk patients of metabolic, liver and cardiovascular disease complications in clinical practice.

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“…The FIB-4 index is a marker of liver brosis based on metabolic-associated fatty liver disease. [15] The signi cance of waist circumference as a risk factor for DR in several studies may be due to fatty liver as a liver lesion in early-stage metabolic syndrome. At this stage, in ammatory cytokines and ROS-related factors might be important for the early progression of DR. A recent study demonstrated that a potent nicotinamide adenine dinucleotide phosphate oxidase 4 inhibitor was effective in treating the early pathological events of DR.…”

Letter to the Editor: Statement of steatotic liver disease: A great leap towards the global standardization

“…Second, the major difference between MAFLD and MASLD is the definition of metabolic dysfunction: any 1 of diabetes, obesity, and more than 2 metabolic risk factors in lean/normal weight subjects in MAFLD or at least 1 of 5 cardiometabolic criteria in MASLD. Our recent study found the diagnostic criteria of MAFLD could better identify the patients at risk of liver and cardiovascular complications than NAFLD 3 . Whether the diagnostic criteria of MASLD have an impact on the clinical outcomes compared with the missed population from the NAFLD population, that is, cryptogenic SLD, deserves further investigation.…”

“…Our recent study found the diagnostic criteria of MAFLD could better identify the patients at risk of liver and cardiovascular complications than NAFLD. [3] Whether the diagnostic criteria of MASLD have an impact on the clinical outcomes compared with the missed population from the NAFLD population, that is, cryptogenic SLD, deserves further investigation. Third, another major difference is the definition of the inclusion of other chronic liver diseases.…”

Potential diagnostic markers shared between non-alcoholic fatty liver disease and atherosclerosis determined by machine learning and bioinformatic analysis

“…A meta-analysis has revealed significant correlation between AS and any degree of fibrosis, the severity of which amplifies this association ( 8 ). The risk of atherosclerosis increases when NAFLD progresses from simple steatosis to NASH ( 9 ).…”