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

Attia, Dina; Aty, Nadia Abdel; Shawket, Ahmed; Said, Ebada; Fouad, Yasser

doi:10.14218/jcth.2021.00485

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…Numerous studies and metaanalyses are in concordance that the MAFLD definition has superior utility for identifying patients at high risk of advanced fibrosis, cardiovascular disease, chronic kidney disease, impaired lung function, impaired cognitive function, quality of life, and morality compared to NAFLD. [2][3][4] The apparent contradiction in this report is likely due to a number of implicit biases. Firstly, for estimation of total causal effects, it is not only unnecessary but also likely harmful to adjust for a variable on a causal path from exposure to outcome, or to incorporate variables that are used in the MAFLD definition.…”

contrasting

confidence: 68%

Letter to the editor: Pitfalls in the outcome differences between NAFLD and MAFLD

Attia

2022

Hepatology

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To the editor, We read with interest the paper by Younossi et al. [1] on the differential impact of nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction associated fatty liver disease (MAFLD) definitions on longterm outcomes of mortality. We commend the authors for undertaking this study. However, we have several concerns with this work, specifically their findings and conclusion that there is no difference in outcomes between the two definitions. Numerous studies and metaanalyses are in concordance that the MAFLD definition has superior utility for identifying patients at high risk of advanced fibrosis, cardiovascular disease, chronic kidney disease, impaired lung function, impaired cognitive function, quality of life, and morality compared to NAFLD. [2][3][4] The apparent contradiction in this report is likely due to a number of implicit biases. Firstly, for estimation of total causal effects, it is not only unnecessary but also likely harmful to adjust for a variable on a causal path from exposure to outcome, or to incorporate variables that are used in the MAFLD definition. [5] This has likely produced an overadjustment bias that typically biases toward the null-hypothesis and results in an imprecise relative risk with reduced statistical significance. [5] Overadjustment bias can be easily dealt with: the variables that are overadjusted should be removed from the multivariable analyses. We would be very interested in the results from a multivariable analysis that is unlikely to suffer from overadjustment. Dealing correctly with comorbidities is especially important when assessing the outcome of patients with MAFLD, as metabolic comorbidities are by definition, and in published reports, more prevalent in individuals with MAFLD compared to NAFLD. Notably, the authors did not show a similarly adjusted model for NAFLD. [3,4] In addition, analysis of the nonoverlapping patients between MAFLD only and NAFLD definitions is not presented-this is the group that is distinct between the two terms.Space restrictions limit our ability to present all our concerns. However, based on the above errors, we have concerns about the validity, meaningfulness, and impact of this study.

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contrasting

confidence: 68%

Letter to the editor: Pitfalls in the outcome differences between NAFLD and MAFLD

Attia

2022

Hepatology

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“…Although this study has limitations (small sample size of NAFLD only), it also supports patient-based evidence arguing for the use of the new definition. 45 A similar viewpoint is stated by Fouad et al. 46 in a recent review, in which they argue that diagnosing MAFLD in hepatitis C virus (HCV) patients after sustained virologic response (SVR) will increase quality of life in these patients.…”

Section: Evidence That the New Definition ‘Mafld’ Might Advance The F...mentioning

confidence: 65%

“…Authors concluded that improvement of fatty liver disease management, reduction of overdiagnosis and overtreatment in primary care, the key area in which most of the patients are seen, and more importantly reduction of underdiagnosis might be enabled by a better disease definition. Zhang et al 43 45 A similar viewpoint is stated by Fouad et al 46 in a recent review, in which they argue that diagnosing MAFLD in hepatitis C virus (HCV) patients after sustained virologic response (SVR) will increase quality of life in these patients.…”

Section: Mafld: What 2 Years Of the Redefinition Of Fatty Liver Disea...mentioning

confidence: 69%

MAFLD: what 2 years of the redefinition of fatty liver disease has taught us

Grabherr

Grander

Effenberger

et al. 2022

Therapeutic Advances in Endocrinology

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Metabolic dysfunction–associated fatty liver disease (MAFLD) has appeared as the leading liver disease worldwide. Whereas the terminology nonalcoholic fatty liver disease (NAFLD) mainly reflected a negative selection and exclusion of alcohol-related liver disease (ALD), the new definition made its focus on the association of MAFLD with overweight/obesity, type 2 diabetes and metabolic risk factors especially also in normal weight/lean subjects. Several studies from the past 2 years have now used the new definition and have provided substantial information that this new definition might be accurate. Studies from the past 2 years have provided evidence that the new definition might be especially advantageous in the characterization and identification of patients with significant fibrosis. This has also been demonstrated in the well-known Rotterdam study in which the MAFLD-only group showed a higher rate of fibrosis and liver stiffness. MAFLD might also be able to predict all-cause mortality as demonstrated in the Third National Health and Nutrition Examination Survey. Furthermore, MAFLD might improve characterization of the cardiovascular risk of this patient population. As the term MAFLD has not yet been accepted universally, it remains important to coordinate efforts globally to adapt to this new definition and especially involve all specialities dealing with metabolic disorders such as diabetologists to further improve its definition and to prepare the medical community for its future use. The aim of this review is to summarize and critically address evidence emerging over the past 2 years that usage of the term MAFLD could be helpful in daily clinical practice.

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“… 15 There is also evidence that MAFLD, but not NAFLD, may have an adverse impact on quality of life. 16 …”

Section: Epidemiologymentioning

confidence: 99%

“…15 There is also evidence that MAFLD, but not NAFLD, may have an adverse impact on quality of life. 16 In another study that relied on NHANES-III data, 17 MAFLD was associated with a 17% increased risk of all-cause mortality [hazard ratio (HR): 1.17; 95% confidence interval (CI):…”

Section: General Prevalence and Characteristics Of Mafld Versus Nafldmentioning

confidence: 99%

Epidemiology, natural history, and diagnosis of metabolic dysfunction-associated fatty liver disease: a comparative review with nonalcoholic fatty liver disease

Kaya

Yılmaz

2022

Therapeutic Advances in Endocrinology

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Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is the most common chronic liver disease worldwide – with an estimated global prevalence of 37%. Different from nonalcoholic fatty liver disease (NAFLD), which is an exclusion diagnosis, MAFLD is defined by a set of positive criteria. This recent change in terminology is challenging because MAFLD and NAFLD denote two similar, albeit not identical, clinical populations. When the diagnostic criteria for MAFLD are applied, liver histology appears more severe and clinical outcomes are less favorable. However, the clinical management of MAFLD and NAFLD remains similar. While liver biopsy is still the reference standard for achieving a final diagnosis, noninvasive imaging- or biomarker-based diagnostic modalities are currently gaining momentum. However, liver biopsy should be recommended when diagnostic challenges exist. In this review, we compared the epidemiology, natural history, and diagnosis of MAFLD with respect to the traditional NAFLD definition.

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

Cited by 8 publications

References 12 publications

Letter to the editor: Pitfalls in the outcome differences between NAFLD and MAFLD

Letter to the editor: Pitfalls in the outcome differences between NAFLD and MAFLD

MAFLD: what 2 years of the redefinition of fatty liver disease has taught us

Epidemiology, natural history, and diagnosis of metabolic dysfunction-associated fatty liver disease: a comparative review with nonalcoholic fatty liver disease

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