Abstract

Recently, international experts have put forward a modified criterion to redefine nonalcoholic fatty liver disease (NAFLD) as metabolic-associated fatty liver disease (MAFLD). It is suspected that outcomes such as mortality may differ for these clinical entities. We studied the impact of MAFLD and NAFLD on the all-cause and cause-specific mortality in US adults.We analyzed data from 7,761 participants in the Third National Health and Nutrition Examination Survey and their linked mortality through 2015. NAFLD was diagnosed by ultrasonographic evidence of hepatic steatosis without other known liver diseases. MAFLD was defined based on the criteria proposed by an international expert panel. The Cox proportional hazard model was used to study all-cause mortality and cause-specific mortality between MAFLD and NAFLD with adjustments for known risk factors.During a median follow-up of 23 years, individuals with MAFLD had a 17% higher risk for all-cause mortality (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.04-1.32). Furthermore, MAFLD was associated with a higher risk for cardiovascular mortality. NAFLD per se did not increase the risk of all-cause deaths. Individuals who met both definitions were noted to have a higher risk for all-cause mortality (HR: 1.13, 95% CI: 1.00-1.26). Also, MAFLD without NAFLD had 1.7-fold higher all-cause mortality (HR: 1.66, 95% CI: 1.19-2.32). Individuals with advanced fibrosis and MAFLD had higher estimates for all-cause mortality than those with advanced fibrosis and NAFLD.In this US population-based study, MAFLD was associated with increased risk of all-cause mortality, while NAFLD demonstrated no association with all-cause mortality after adjusting for metabolic risk factors.Our findings provide further support to the idea that nonalcoholic fatty liver disease (NAFLD) is a part of a broader multi-system disease that also includes obesity, diabetes, high blood pressure, and high cholesterol. Therefore, re-defining NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD) may provide a better understanding of predictors that may increase the risk of death.

View details for DOI 10.1016/j.jhep.2021.07.035

View details for PubMedID 34380057