Comparing the Diagnostic Criteria of MAFLD and NAFLD in the Chinese Population: A Population-based Prospective Cohort Study

Abstract

Background and Aims Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new concept, proposed in 2020; however, its applicability in Asia populations has yet to be evaluated. Therefore, we aimed to compare the difference in epidemiological and clinical characteristics between MAFLD and non-alcoholic fatty liver disease (NAFLD) among Asian populations. Methods Based on the Jinchang cohort, 30,633 participants were collected. The prevalence and incidence of MAFLD and NAFLD were used to analyze the epidemic characteristics and its overlapping effects. In addition, the corresponding clinical characteristics of the two diagnostic criteria populations were compared. Results The prevalence rates of MAFLD and NAFLD were 21.03% and 18.83%, respectively. After an average 2.28-year follow-up, the incidence densities of MAFLD and NAFLD were 41.58 per 1,000 person-years and 37.69 per 1,000 person-years, respectively. With the increase of baseline age, body mass index (BMI), and waist circumference (WC) levels, the prevalence and incidence of MAFLD and NAFLD were on the rise (all p trend <0.05). Among the total patients diagnosed at baseline or follow-up, most patients had both MAFLD and NAFLD, accounting for 78.84% and 82.88%, respectively. Compared with NAFLD, MAFLD patients had greater proportions of males and metabolic diseases (diabetes, dyslipidemia), and had higher BMI, WC, liver enzymes, blood glucose, and lipid levels in the baseline diagnosis patients ( p <0.05). Additionally, lean MAFLD patients had higher metabolic disorders than lean NAFLD patients ( p <0.05). Conclusions Compared with NAFLD, the newly proposed definition of MAFLD is more practical and accurate, and it can help identify more fatty liver patients with high-risk diseases.

MAFLD Not NAFLD is Associated with Impairment of Health-related Quality of Life

“…In conclusion, in line with the results reported by Yu et al ., 1 our data show that patients with MAFLD but not NAFLD only experienced significant impairment in HRQOL and performance of physical activities than healthy controls. This study adds to the growing body of evidence demonstrating the utility of the novel MAFLD definition 4 , 5 to identify patients at high risk of hepatic fibrosis, cardiovascular disease, chronic kidney disease, colonic polyps, and mortality 6 – 9 and the importance of consideration of MAFLD criteria in the clinical management of fatty liver disease.…”

“…We read with great interest the article by Yu et al . 1 who reported that the metabolic dysfunction-associated fatty liver disease (MAFLD) criteria are more practical and improve the identification of high-risk patients with fatty liver disease compared with the previous nonalcoholic fatty liver disease (NAFLD) criteria. NAFLD and steatohepatitis are associated with significant impairment of health-related quality of life (HRQOL), 2 and as fibrosis progresses, the negative impact on HRQOL becomes more pronounced.…”

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).…”

Relationship between the dynamics of non-alcoholic fatty liver disease and incident diabetes mellitus

“…The patients with MAFLD tended to have more severe metabolic derangements at baseline and poorer clinical outcomes such as incident general obesity, central obesity, DM and cerebrovascular events compared to patients with NAFLD in several retrospective studies 36 – 38 . Therefore, we tried to analyze the subjects according to change pattern of MAFLD additionally.…”