Comparison of MAFLD and NAFLD diagnostic criteria in real world

Abstract

Background and aims Metabolic associated fatty liver disease (MAFLD) is a novel concept proposed in 2020, the utility of which has not been tested and validated in real world. We aimed to compare the characteristics of MAFLD and non‐alcoholic fatty liver disease (NAFLD). Methods The data was retrieved from the third National Health and Nutrition Examination Surveys of the United States, which is an unbiased survey dataset and frequently used for the study of fatty liver disease. Results A total of 13 083 cases with completed ultrasonography and laboratory data were identified from the NHANES III database. MAFLD was diagnosed in 4087/13 083 (31.24%) participants, while NAFLD in 4347/13 083 (33.23%) amongst the overall population and 4347/12 045 (36.09%) in patients without alcohol intake and other liver diseases. Compared with NAFLD, MAFLD patients were significantly older, had higher BMI level, higher proportions of metabolic comorbidities (diabetes, hypertension) and higher HOMA‐IR, lipid and liver enzymes. MAFLD patients with alcohol consumption were younger than those without, and more likely to be male. They had less metabolic disorder but higher liver enzymes. There were more cases with advance fibrosis in MAFLD patients with alcohol consumption. Conclusion MAFLD definition is more practical for identifying patients with fatty liver disease with high risk of disease progression.

Authors’ response to ‘Concordance of MAFLD and NAFLD diagnostic criteria in "real‐world" data’

“…We thank Prof. Targer for his interest on our study. 1 We totally agree with him on the concordance between MAFLD (metabolic dysfunction-associated fatty liver disease) and NAFLD (nonalcoholic fatty liver disease), at least among the participants from National Health and Nutrition Examination Surveys (NHANES) 1988-1994 database. 2 We would also like to emphasize that a significant minority of patients with severe liver steatosis go undiagnosed and not captured by the recently proposed MAFLD criteria.…”

“…This research is supported by Chinese National 13th Five-Year Plan's Science and Technology Projects (2017ZX10202201), Fujian Province Health Youth Research Project (2019-1-37). Jiaofeng Huang 1,2…”

Non‐alcoholic fatty liver disease to metabolic dysfunction‐associated fatty liver disease: Conceptual changes for clinicians, researchers and patients

“…For example, a recent real-world study found that around 15% of patients with NAFLD who failed to meet MAFLD diagnostic criteria exhibited significantly lower non-invasive fibrosis scores than patients with MAFLD. 13,47 Moreover, details of the inclusion or exclusion criteria can be flexibly modified according to the study goal. For example, in observational studies it is feasible to recruit patients with comorbidities of MAFLD and other liver diseases to explore the interaction between these diseases; whereas in clinical trials for new drugs it is also feasible to recruit a subgroup of patients with MAFLD with common metabolic characteristics according to the pharmacological mechanism for enhanced sampling homogeneity.…”

NAFLD and liver transplantation: Disease burden, current management and future challenges

“…1 Recently the term metabolic dysfunctionassociated fatty liver disease (MAFLD) has been proposed to better describe liver disease associated with metabolic dysfunction, 2 leading to discussions within the scientific community regarding potential consequent changes in diagnosis, clinical management and drug development. [3][4][5] Until now, NAFLD has been diagnosed by the presence of hepatic steatosis on radiological imaging or biopsy, after ruling out all other reasonable causes (e.g. alcohol consumption).…”