Metabolic dysfunction-associated fatty liver disease: from basic research to clinical application.

Letter regarding “A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement”

Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study

NAFLD vs. MAFLD – It is not the name but the disease that decides the outcome in fatty liver

Meaning of non-overlapping patients between the MAFLD and NAFLD definitions.

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease associated with various metabolic disorders. Metabolic dysfunction-associated fatty liver disease (MAFLD) emphasizes metabolic dysfunction in NAFLD. Although the relationship between NAFLD and colorectal adenomas has been suggested, the effect of MAFLD on colorectal adenoma has yet to be investigated. In this study, we examined the relationship between NAFLD/MAFLD and colorectal adenoma in comparison with other metabolic factors. Methods: Examinees who underwent colonoscopy and abdominal ultrasonography on the same day from January 2012 to December 2012 were included. NAFLD was diagnosed according to the findings of ultrasonography. The Fibrosis-4 (FIB-4) index was used as a surrogate marker for advanced hepatic fibrosis. A logistic regression model was used to analyze the risk of NAFLD/MAFLD for colorectal adenoma. Results: The prevalence of NAFLD and MAFLD was 37.5% and 32.8%, respectively. In the multivariate analysis, male sex, older age, diabetes, and smoking increased the risk of colorectal adenoma. NAFLD and MAFLD were the most important risk factors for colorectal adenoma only in females [adjusted odds ratio (OR) 1.43 and 95% confidence interval (CI) 1.01–2.03, and OR 1.55, 95% CI 1.09–2.20, respectively]. NAFLD and MAFLD with an advanced fibrosis index were significantly associated with an increased risk of colorectal adenoma. (NAFLD: OR 1.38, 95% CI, 1.04–1.83, p = 0.027; MAFLD: OR 1.45, 95% CI, 1.13–1.96, p = 0.004, respectively). Conclusion: NAFLD and MAFLD were significantly associated with a higher risk of colorectal adenomas, especially in females. NAFLD and MAFLD with advanced fibrosis were associated with an increased risk of colorectal adenoma. Colonoscopic examinations may be emphasized for patients with NAFLD/MAFLD, for women, or patients with the presence of hepatic fibrosis.

To study the prevalence and predictors of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) in women with polycystic ovarian syndrome (PCOS). Seventy-eight PCOS patients and 78 age and body mass index (BMI)-matched controls were studied. PCOS was diagnosed by Rotterdam criteria. Clinical examination, biochemical, and hormonal investigations, and transabdominal sonography were done for all participants. Based on gray-scale sonography, NAFLD was graded as 0, 1, 2, and 3. MAFLD was diagnosed when imaging or serological evidence of fatty liver disease was present and one of the following three criteria was met: overweight/obesity, diabetes, or metabolic disorders. Women with PCOS had a higher prevalence of NAFLD (53.8% vs. 17.9%; p < 0.001), MAFLD (70.5% vs. 48.7%; p < 0.01), insulin resistance (HOMA-IR 2.8 ± 1.3 vs. 1.4 ±0.3; p < 0.001) and metabolic syndrome (51.3% vs. 10.3%; p < 0.001) and higher values of waist-hip ratio (0.88 ± 0.1 vs. 0.83 ± 0.1; p < 0.001), alaninetransferase (44.1 ± 19.7 vs. 30.3 ± 7.6; p < 0.001), and free androgen index (FAI; 7.8 ± 4.4 vs. 3.4 ± 1.7; p < 0.001) than controls. Twenty-three percent of PCOS patients with NAFLD and 18.4% with MAFLD had Grades 2and 3 disease. Among different PCOS phenotypes, phenotype A was maximally affected with NAFLD and MAFLD. Multiple regression analysis showed that PCOS status and FAI were the predicting factors for NAFLD. MAFLD was significantly associated with hepatic steatosis index (HSI). PCOS patients were at a higher risk for NAFLD and MAFLD than age- and BMI-matched controls. The prevalence of NAFLD and MAFLD was highest in phenotype A. Hyperandrogenism is a predictor of NAFLD in PCOS.

Background: The recent change of terminology from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) has raised heated discussion. We aim to investigate the association of MAFLD or NAFLD with all-cause and cause-specific mortality to compare the outcomes of the two diagnostic criteria in population-based study.Methods: We recruited 12,480 participants from the Third National Health and Nutrition Examination Survey (NHANES III) with matched mortality data in 2015. Participants were divided into four groups for survival analysis: without NAFLD or MAFLD, with only NAFLD, only MAFLD. Cox proportional hazard regression was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality. Subgroup analysis were applied in MAFLD patients.Results: The weighted prevalence of MAFLD and NAFLD was relatively 27.4 and 27.9%. Participants with NAFLD or MAFLD were largely overlapped (weighted Cohen's kappa coefficient 0.76). MAFLD increased the overall risk for total mortality in a greater magnitude than NAFLD [HR 2.07 (95% CI 1.86, 2.29) vs. 1.47 (1.20, 1.79)], However, the difference was non-significant after metabolic parameters were adjusted. Risks for cardiovascular, neoplasm, and diabetes-related mortality were similar between MAFLD and NAFLD. Referring to individuals without both NAFLD and MAFLD, individuals with only NAFLD showed reduced total mortality [HR 0.48 (0.34, 0.68)] and neoplasm mortality [HR 0.46 (0.24, 0.89)] in crude. Nevertheless, individuals with only MAFLD independently increased the risk for total mortality [adjusted HR 1.47 (1.22, 1.77)] and neoplasm mortality [aHR 1.58 (1.09, 2.28)]. The risk for overall mortality in MAFLD was consistent between subgroups except for race-ethnicity and whether secondary to viral hepatitis.Conclusions: Participants with MAFLD or NAFLD were highly concordant. MAFLD showed greater risk for all-cause mortality and equal risk for cause-specific mortality referring to NAFLD. The new terminology excluded participants with lower mortality risk and included participants with higher risk. Drug development for MAFLD should consider ethnic differences.

Yet more evidence that MAFLD is more than a name change

Lean Fatty Liver Disease: Through Thick and Thin

Do we need a new cut-off for FIB-4 in the metabolic dysfunction-associated fatty liver disease era?

Metabolic dysfunction-associated fatty liver disease and the risk of hepatocellular carcinoma

The term metabolic dysfunction–associated fatty liver disease (MAFLD) has been proposed based on a redefinition of the nonalcoholic fatty liver disease (NAFLD) criteria. Our study aimed to address the knowledge gap by comparing the diagnostic accuracy of MAFLD and NAFLD criteria in identifying significant fibrosis among patients with hepatic steatosis. A cross-sectional study was conducted on 2626 patients with hepatic steatosis treated at Beijing Ditan Hospital between January 2009 and December 2022. Patients with viral hepatitis were excluded. Significant fibrosis was defined as a Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) score F ≥ 2. MAFLD and NAFLD were diagnosed in 478 and 428 patients, respectively. Clinicopathological characteristics were compared between the MAFLD+ NAFLD– group (patients who met the criteria for MAFLD but not NAFLD) and MAFLD– NAFLD+ group (patients who met the criteria for NAFLD but not MAFLD). A total of 743 patients with histologically verified hepatic steatosis were analyzed. The MAFLD+ NAFLD– group comprised 163 (21.9%) and the MAFLD– NAFLD+ group comprised 113 (15.2%) patients. Patients in the MAFLD+ NAFLD– group were older and more likely to be male and had higher body mass index and liver stiffness levels than those in the MAFLD– NAFLD+ group. The prevalence of significant fibrosis was higher in the MAFLD+ NAFLD– group than in the MAFLD– NAFLD+ group (43.6% vs 15.9%, P < .001). The MAFLD criteria may be a better indicator of fibrosis than the NAFLD criteria. Fibrosis in patients with MAFLD can be determined by metabolic disorders, not excessive alcohol consumption.

BackgroundA recently proposed diagnostic criteria of metabolic dysfunction-associated fatty liver disease (MAFLD) is more available for various clinical situations than nonalcoholic fatty liver disease (NAFLD), but understanding about differences between NAFLD and MAFLD in clinical practice remains limited in the general adult urban population in China.MethodsA total of 795 subjects were recruited from Wu Song Branch of Zhongshan Hospital who participated in the general health assessment. Examination results was obtained through analysis of blood samples and abdominal ultrasonography. Participants were divided into four subgroups according to whether they had NAFLD or MAFLD (NAFLD- MAFLD-, NAFLD + MAFLD-, NAFLD- MAFLD + and NAFLD + MAFLD+).ResultsAmong the urban healthy adults investigated, 345 people (43.4%) were diagnosed with NAFLD and 356 people (44.8%) with MAFLD. No significant differences in the prevalence, age, fasting blood glucose, glycosylated hemoglobin, liver enzyme examination, percentage of overweight, hypertension or dyslipidaemia were found between NAFLD and MAFLD patients. Patients with MAFLD had worse metabolic disorders than NAFLD + MAFLD- patients. The NAFLD fibrosis score (NFS) of the NAFLD- MAFLD + group was higher than that of the NAFLD + MAFLD- group. Higher proportion of patients in the NAFLD- MAFLD + group have NFS ≥-1.455.ConclusionMAFLD criteria have similar prevalence and patient characteristics compared with previous NAFLD but help to identify a group of patients with high risks of metabolic disorders and liver fibrosis who have been missed with NAFLD, and has superior utility.

The Prevalence and Determinants of NAFLD and MAFLD and Their Severity in the VA Primary Care Setting

Reply to: Correspondence on “A new definition for metabolic associated fatty liver disease: an international expert consensus statement”: MAFLD: Moving from a concept to practice