Diabetic MAFLD is associated with increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis patients

Abstract

Metabolic dysfunction‐associated fatty liver disease (MAFLD) can coexist with chronic viral hepatitis. MAFLD is a heterogeneous disease because the diagnostic criteria include various metabolic traits. We aimed to identify patients at high risk of poor long‐term outcomes based on MAFLD subgroups in chronic viral hepatitis patients. We evaluated 63 273 chronic hepatitis B and C patients. Patient with a fatty liver index ≥30 was defined to have hepatic steatosis. MAFLD was defined as the presence of hepatic steatosis with any one of the following three conditions, overweight/obesity, type 2 diabetes or ≥2 metabolic risk factors. The prevalence of MAFLD was 38.4% (n = 24 290). During a median 8.8‐year follow‐up, 1839 HCCs and 2258 deaths were documented in MAFLD patients. Among MAFLD patients, diabetes could identify patients at high risk of HCC and mortality, whereas overweight/obesity and metabolic risk factors did not. Compared with non‐MAFLD patients, risk of HCC and mortality was significantly higher in diabetic MAFLD patients (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] = 1.26‐1.43 for HCC; aHR = 1.15, 95% CI = 1.08‐1.22 for mortality). Risk of HCC and mortality was significantly higher in diabetic MAFLD patients (aHR = 1.40, 95% CI = 1.26‐1.55 for HCC; aHR = 1.77, 95% CI = 1.63‐1.93 for mortality) compared with non‐diabetic MAFLD patients. Diabetic MAFLD is associated with increased risk of HCC and mortality among chronic viral hepatitis patients. Our findings highlight the need for close surveillance and effective treatment for these high‐risk patients to reduce HCC and mortality in patients with chronic viral hepatitis.

Effect of metabolic dysfunction‑associated fatty liver disease on the risk of hepatocellular carcinoma in patients with chronic hepatitis B: A systematic review and meta‑analysis

“…After a secondary screening, 18 studies were included that fully satisfied the eligibility criteria (Fig. 1) (11,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…It is important to have uniformity in diagnostic criteria for producing consistent results. However, the criteria for MAFLD diagnosis have evolved over time and a number of the older studies included in the present meta-analysis used previous definitions (17,19), while newer studies adopted more recent criteria (20)(21)(22). Establishing a single standardized criterion would exclude a significant portion of available literature, potentially leading to loss of valuable insights.…”

What Is the Role of Minimally Invasive Liver Surgery in Treating Patients with Hepatocellular Carcinoma on Cirrhosis?

“…The incidence of metabolic-related HCC is increasing worldwide and currently represents the fastest growing cause of HCC, with similar reports from Europe, North America, and East Asia [ 25 , 26 , 27 , 28 , 29 ]. Patients with MASLD, especially in the presence of diabetes, may be at particular risk [ 30 ]. In Italy, this epidemiological trend has been particularly pronounced, as recently shown by Vitale A et al [ 31 ], who demonstrated that metabolic-associated HCC is overtaking HCV-related HCC.…”

Comment on “Diabetic MAFLD is associated with increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis patients”

“…tab. 4 of the study, 1 it is noteworthy that compared to participants with no overweight, those classified as overweight exhibit a significant decrease in mortality rates (0.87 [0.81-0.92]). Even after adjusting for potential confounding factors, this trend continues to persist, albeit at a slightly altered ratio of 0.79 [0.73-0.82].…”