The FibroScan-aspartate aminotransferase score can stratify the disease severity in a Japanese cohort with fatty liver diseases

Abstract

This study aimed to prove that the FibroScan-aspartate aminotransferase (FAST) scores can be used to stratify disease severity in a Japanese cohort with fatty liver diseases [metabolic dysfunction-associated fatty liver disease (MAFLD) and nonalcoholic fatty liver disease (NAFLD)]. All the participants (n = 2254) underwent liver stiffness measurements and controlled attenuation parameter assessments. We compared the clinical characteristics of the patients with MAFLD and NAFLD using the FAST scores and explored the independent determinants of FAST scores ≥ 0.35, which indicated possible progressive disease. Overall, MAFLD was diagnosed in 789 patients (35.0%), while NAFLD was diagnosed in 618 (27.4%). The proportion of patients that had a condition that suggested progressive liver disease was higher in those with MAFLD than in those with NAFLD [68 (8.6%) vs 48 (7.7%)]. The area under the receiver-operating characteristic curve of the FAST score for diagnosing advanced fibrosis was 0.969 in MAFLD and 0.965 in NAFLD. Multivariate analyses determined that diabetes mellitus, alanine aminotransferase (ALT) levels, fatty liver index, and Fibrosis-4 index independently predict FAST scores ≥ 0.35 in patients with MAFLD. ALT levels had the strongest correlation with the FAST scores (p = 0.7817). The FAST score could stratify the disease severity in the Japanese cohort with fatty liver diseases.

Systematically comparing epidemiological and clinical features of MAFLD and NAFLD by meta‐analysis: Focusing on the non‐overlap groups

“…Seven cohort studies among the general population reported data on ALT and AST levels for MAFLD and NAFLD. [5][6][7][8][9]15,18 Despite the considerable overlap between NAFLD and MAFLD (±80%), we observed slightly higher levels of ALT (mean difference 1.1 U/L; 95% CI 0.6-1.6) and AST (mean difference 0.8 U/L; 95% CI 0.4-1.2) among those with MAFLD compared to NAFLD (Figure S4). These differences became more evident in the non-overlapping groups of MAFLD-only and NAFLD-only.…”

“…Among those with FLD, 79.9% (95% CI 75.3-83.9) met both NAFLD and MAFLD definitions (overlap-FLD), 4.0% (95% CI 2.4-6.4) did not meet the novel MAFLD criteria but had NAFLD (NAFLD-only) and 15.1% (95% CI 11.5-19.5; Figure 3) was additionally captured by the novel MAFLD definition (MAFLD-only). [6][7][8][9][10]12,14,15,17,18 Among the non-general population, 11,13,16,19 MAFLD-only seems to be even more frequent (27.4%, 95% CI 13.0-48.9), while the prevalence of NAFLD-only remains low (5.0%, 95% CI 1.7-13.7; Figure S2).…”

“…The transition from the conventional definition of non‐alcoholic fatty liver disease (NAFLD), which emphasises the alcohol stigma, to an aetiology and inclusion‐based definition of MAFLD has been explored in numerous cohorts 5‐21 . In general, almost all cases of NAFLD are identified by MAFLD and similar prevalence rates of NAFLD and MAFLD are observed.…”

Lifestyle changes during the coronavirus disease 2019 pandemic impact metabolic dysfunction–associated fatty liver disease

“…Daily alcohol consumption was calculated in grams using our modified template 18,19 . Frequency of alcohol intake was classified as 1 day per week, 3 days per week, or 7 days per week.…”

“…Daily alcohol consumption was calculated in grams using our modified template. 18,19 Frequency of alcohol intake was classified as 1 day per week, 3 days per week, or 7 days per week. Each participant's average alcohol consumption was classified as 10, 30, 50 or 70 g per day on days when alcohol was consumed.…”