MAFLD better predicts the progression of atherosclerotic cardiovascular risk than NAFLD: Generalized estimating equation approach

Abstract

Aim: Metabolic associated fatty liver disease (MAFLD) partly overlaps with nonalcoholic fatty liver disease (NAFLD). Thus, using a generalized estimating equation (GEE) approach, we aimed to investigate the difference in worsening of atherosclerotic cardiovascular disease (ASCVD) risk between patients with MAFLD and NAFLD. We also investigated factors related to the difference between the two groups. Methods:We enrolled 2306 subjects with fatty liver (MAFLD 80.7%, NAFLD 63.4%). Subjects with MAFLD/NAFLD were sub-classified into three groups: NAFLD with no metabolic dysfunction (non-Met NAFLD), overlapping, and MAFLD with moderate alcohol consumption (mod-Alc MAFLD). ASCVD risk was estimated by non-invasive tests, including the Suita score. An event was defined as worsening of these scores from the low-risk to the high-risk group. Independent factors for the event were analyzed by Cox regression analysis with the GEE. Results:In Cox regression analysis, MAFLD (HR 1.08, 95% CI 1.02-1.15, p = 0.014) and alcohol consumption (20-39 g/day; HR 1.73, 95% CI 1.26-2.36, p = 0.001) were independently associated with worsening of the Suita score. In a subanalysis, the incidence of the event was significantly lower in non-Met NAFLD than in the overlapping group (HR 0.70, 95% CI 0.50-0.98, p = 0.042). However, no significant difference was observed in the incidence between the overlapping and mod-Alc MAFLD group (HR 1.19, 95% CI 0.89-1.58, p = 0.235). Conclusions:The GEE approach demonstrates that MAFLD better identifies patients with worsening of ASCVD risk than NAFLD. Moreover, the superiority of

Risk of cardio-nephro-metabolic disease from NAFLD to MAFLD: fact or fiction?

“…Patients with MAFLD were found to have a higher risk for cardiovascular adverse outcomes and a higher incidence of all-cause mortality compared to those with NAFLD [97,99] . Furthermore, patients with concomitant MAFLD and viral hepatitis, but not NAFLD and viral hepatitis, had a significantly increased cardiovascular risk as assessed by cardiovascular disease risk estimator and atherogenic indices [100] . Tsutsumi et al [101] recently used a generalized estimating equation approach to investigate the difference in atherosclerotic cardiovascular disease (ASCVD) risk between patients with MAFLD and NAFLD.…”

Redefinition of Fatty Liver Disease from NAFLD to MAFLD through the Lens of Drug Development and Regulatory Science

“…Emerging evidence shows that the diagnostic criteria in the MAFLD definition identify patients with significant hepatic fibrosis, cardiovascular disease, or chronic kidney disease, [18][19][20]64 and those who would benefit from evaluating genetic risks for fatty liver 65 better than the previous NAFLD criteria. The utility of the MAFLD criteria have also been shown in patients with other diseases such as hepatitis B, 66 hepatitis C, 67,68 human immunodeficiency virus, 69 celiac disease, 70 Gaucher disease, 71 and myotonic dystrophy type 1, 72 which need to be excluded to diagnose NAFLD.…”

Biomarkers of Metabolic (Dysfunction)-associated Fatty Liver Disease: An Update

“…4,[11][12][13][14][15][16][17][18][19] Notably, a number of studies have provided evidence that the criteria associated with MAFLD are more effective than the criteria associated with NAFLD when it comes to identifying patients with significant fibrosis as well as chronic kidney and cardiovascular diseases, including those with fatty liver disease and other concomitant liver diseases. [20][21][22][23][24][25] Instead of the dichotomous classification of MAFLD patients into nonalcoholic steatohepatitis (NASH) and non-NASH, the MAFLD proposal is suggesting considering hepatic inflammation as a continuous variable, similar to that with other liver diseases, which should have implications in improving patients' characterisations. 11 In this context, there is increasing recognition that fibrosis may develop on the ground of steatosis with little if any inflammatory changes.…”