Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

Abstract

Background and Aims Cardiovascular disease (CVD) is the main cause of mortality in subjects with non‐alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction‐associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk. Methods Subjects who underwent a comprehensive medical check‐up were recruited (2014–2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis‐4 index, aspartate aminotransferase to platelet ratio index, or FibroScan‐aspartate aminotransferase score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score > 10%. Results Of the study population (n = 78 762), 27 047 (34.3%) and 24 036 (30.5%) subjects had MAFLD and NAFLD respectively. A total of 1084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all p < .001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR] = 1.10, p = .038), whereas NAFLD was not (all p > .05). MAFLD (aOR = 1.40) or NAFLD (aOR = 1.22) was independently associated with high probability of ASCVD after full adjustment respectively (all p < .001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup respectively (all p < .05). Conclusion MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.

Measuring the impact of the updated Steatotic liver disease nomenclature and definition

“…3,4 BypromotingthecomparisonofMAFLDwiththehistoricaldefinitionofnonalcoholicfattyliverdisease(NAFLD), 5 Liver International contributedtoshowthatMAFLDissuperiortoNAFLDinidentifying individualsatriskofliverfibrosisandbothhepaticandnon-hepatic events(suchasdiabetesandcardiovasculardisease),includinginpatientswithconcurrentliverdiseases,evenifpatientswithNAFLDonly without metabolic dysfunction remain at a slightly increased riskthanthegeneralpopulation. [6][7][8][9][10][11][12] Basedonthesepremises,toachieveanevenlargerconsensus, aninternationalmulti-stakeholdergroupinvolvingmultiplescientific societies, endocrinologists, paediatricians, experts in public health and patients' representatives recently published the results of a Delphiconsensusprocessthatledtotheproposalofthe"metabolic dysfunction steatotic liver disease" (MASLD) definition. 13…”

“…Luca Valenti 1,2 Alessio Aghemo 3,4 Alejandro Forner 5,6 SalvatorePetta 7 StefanoRomeo 8,9,10 PierreNahon 11,12,13…”

“…By promoting the comparison of MAFLD with the historical definition of nonalcoholic fatty liver disease (NAFLD), 5 Liver International contributed to show that MAFLD is superior to NAFLD in identifying individuals at risk of liver fibrosis and both hepatic and non‐hepatic events (such as diabetes and cardiovascular disease), including in patients with concurrent liver diseases, even if patients with NAFLD‐only without metabolic dysfunction remain at a slightly increased risk than the general population 6–12 …”

Modified triglyceride-glucose index indices are reliable markers for predicting risk of metabolic dysfunction-associated fatty liver disease: a cross-sectional study

“…Thus, a patient can be identified with both MAFLD and NAFLD or might not be identified at all if the criteria for only one or the other are applied, such as in cases with an alcohol-related origin accompanied by metabolic abnormalities. Although controversy about the paradigm shift to MAFLD is ongoing, much research is being published about the clinical importance of MAFLD ( 6 – 8 ).…”

Liver Fibrosis Scores and Coronary Artery Disease: Novel Findings in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease

“…Since the introduction of the term "metabolic dysfunction-associated fatty liver disease", there have been key areas in which the superiority of MAFLD over traditional NAFLD terminology has been demonstrated. [41][42][43] The application of the new term MAFLD has shown advantages in assessing the risk of liver and extrahepatic mortality, as well as identifying high-risk individuals. [44][45][46] Our study extended these previous observations to a new concept and discovered significant results regarding the predictive value of noninvasive liver fibrosis scores for CAD in patients with MAFLD.…”