Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study

Lee, Hokyou; Lee, Yong-Ho; Kim, Seung Up; Kim, Hyeon Chang

doi:10.1016/j.cgh.2020.12.022

Cited by 333 publications

(391 citation statements)

References 36 publications

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“…Two recent studies have suggested that the MAFLD criteria can identify patients with a higher degree of disease severity. 11,16 In contrast, another study showed that MAFLD criteria might overlook the clinical and prognostic significance of Non-MR NAFLD. 16 Of note, several recent studies have shown that the clinical characteristics, including renal function and fibrosis markers, of subjects with Non-MR NAFLD might be better than those of subjects with MAFLD.…”

Section: Discussionmentioning

confidence: 99%

“…11,16 In contrast, another study showed that MAFLD criteria might overlook the clinical and prognostic significance of Non-MR NAFLD. 16 Of note, several recent studies have shown that the clinical characteristics, including renal function and fibrosis markers, of subjects with Non-MR NAFLD might be better than those of subjects with MAFLD. 17 However, another study showed that subjects with Non-MR NAFLD had a higher risk of CVD than those with neither NAFLD nor MAFLD, indicating the need for careful assessment and monitoring of this population.…”

Section: Discussionmentioning

confidence: 99%

“…17 However, another study showed that subjects with Non-MR NAFLD had a higher risk of CVD than those with neither NAFLD nor MAFLD, indicating the need for careful assessment and monitoring of this population. 16 In addition, more studies are needed to better elucidate the potential risk that can be the cause of future disease in 'lean' NAFLD without any metabolic dysregulation who was excluded from MAFLD criteria.…”

Section: Discussionmentioning

confidence: 99%

“…In another recent study conducted in Korea, the proportion of subjects with Non-MR NAFLD was only 0.6%. 16 Although the comparison between subjects with Non-MR NAFLD and those with MAFLD was not feasible, the adjusted risk of CVD in subjects with Non-MR NAFLD was slightly increased with statistical significance (hazard ratio=1.09 [95% confidence interval, 1.03-1.15]), when compared to that of the subjects without NAFLD or MAFLD.…”

Section: Missed Populations When Using the Mafld Criteriamentioning

confidence: 99%

“…Another nationwide cohort study from South Korea conducted by Lee et al evaluated the prevalence of FLD, including MALFD and NAFLD, and the associated CVD risk using each of these definitions. 16 From a nationwide health screening database, a total of 9,584,399 subjects (48.5% male) aged 40-64 years between 2009 and 2010 were included. These subjects were categorized by the presence of NAFLD and MAFLD, separately, and by the combination of the two definitions: Neither-FLD, NAFLD-alone (Non-MR NAFLD), MAFLD-alone (MAFLD, but without NALFD), or Both-FLD.…”

Section: Comparison Of Nafld and Mafld: Longitudinal Considerationsmentioning

confidence: 99%

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From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Missed Populations When Using the Mafld Criteriamentioning

confidence: 99%

Section: Comparison Of Nafld and Mafld: Longitudinal Considerationsmentioning

confidence: 99%

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From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

et al. 2021

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Differential risk of 23 site‐specific incident cancers and cancer‐related mortality among patients with metabolic dysfunction‐associated fatty liver disease: a population‐based cohort study with 9.7 million Korean subjects

Chung

Yoo

et al. 2023

Cancer Communications

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Introduction Although an association between metabolic dysfunction‐associated fatty liver disease (MAFLD) and cardiovascular disease or overall mortality has been reported, it is unclear whether there is an association between MAFLD and cancer incidence or mortality. We aimed to investigate the differential risk of all‐ and site‐specific cancer incidence and mortality according to MAFLD subgroups categorized by additional etiologies of liver disease. Methods Using the Korean National Health Insurance Service database, we stratified the participants into three groups: (1) single‐etiology MAFLD (S‐MAFLD) or MAFLD of pure metabolic origin; (2) mixed‐etiology MAFLD (M‐MAFLD) or MAFLD with additional etiological factor(s) (i.e., concomitant liver diseases and/or heavy alcohol consumption); and (3) non‐MAFLD. Hepatic steatosis and fibrosis were defined using the fatty liver index and the BARD score, respectively. Cox proportional hazards regression was performed to estimate the risk of cancer events. Results Among the 9,718,182 participants, the prevalence of S‐MAFLD and M‐MAFLD was 29.2% and 6.7%, respectively. During the median 8.3 years of follow‐up, 510,330 (5.3%) individuals were newly diagnosed with cancer, and 122,774 (1.3%) cancer‐related deaths occurred among the entire cohort. Compared with the non‐MAFLD group, the risk of all‐cancer incidence and mortality was slightly higher among patients in the S‐MAFLD group (incidence, adjusted hazard ratio [aHR] = 1.03; 95% confidence interval [CI]: 1.02−1.04; mortality, aHR = 1.06; 95% CI: 1.04−1.08) and highest among patients with M‐MAFLD group (incidence, aHR = 1.31; 95% CI: 1.29−1.32; mortality, aHR = 1.45; 95% CI: 1.42−1.48, respectively). The M‐MAFLD with fibrosis group (BARD score ≥ 2) showed the highest relative risk of all‐cancer incidence (aHR = 1.38, 95% CI = 1.36–1.39), followed by the M‐MAFLD without fibrosis group (aHR = 1.09, 95% CI = 1.06–1.11). Similar trends were observed for cancer‐related mortality. Conclusions MAFLD classification, by applying additional etiologies other than pure metabolic origin, can be used to identify a subgroup of patients with poor cancer‐related outcomes.

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MAFLD and glomerular hyperfiltration in subjects with normoglycemia, prediabetes and type 2 diabetes: A cross‐sectional population study

Abbate,

Parvanova,

López‐González

et al. 2024

Diabetes Metabolism Res

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BackgroundMetabolic dysfunction‐associated fatty liver disease (MAFLD, 2020 diagnostic criteria) and glomerular hyperfiltration share common risk factors, including obesity, insulin resistance, impaired glucose tolerance, diabetes, dyslipidemia, and hypertension.AimsTo assess the prevalence of MAFLD and its association with glomerular hyperfiltration and age‐related worsening of kidney function in subjects with normoglycemia, prediabetes and type 2 diabetes mellitus (T2DM).MethodsWe analysed data recorded during occupational health visits of 125,070 Spanish civil servants aged 18–65 years with a de‐indexed glomerular filtration rate (GFR) estimated with the chronic‐kidney‐disease‐epidemiological (CKD‐EPI) equation (estimated glomerular filtration rate [eGFR]) ≥60 mL/min. Subjects were categorised according to fasting plasma glucose levels <100 mg/dL (normoglycemia), ≥100 and ≤ 125 mg/dL (prediabetes), or ≥126 mg/dL and/or antidiabetic treatment (T2DM). The association between MAFLD and glomerular hyperfiltration, defined as a de‐indexed eGFR above the age‐ and gender‐specific 95th percentile, was assessed by multivariable logistic regression.ResultsIn the whole study group, MAFLD prevalence averaged 19.3%. The prevalence progressively increased from 14.7% to 33.2% and to 48.9% in subjects with normoglycemia, prediabetes and T2DM, respectively (p < 0.001 for trend). Adjusted odds ratio (95% CI) for the association between MAFLD and hyperfiltration was 9.06 (8.53–9.62) in the study group considered as a whole, and 8.60 (8.03–9.21), 9.52 (8.11–11.18) and 8.31 (6.70–10.30) in subjects with normoglycemia, prediabetes and T2DM considered separately. In stratified analyses, MAFLD amplified age‐dependent eGFR decline in all groups (p < 0.001).ConclusionsMAFLD prevalence increases across the glycaemic spectrum. MAFLD is significantly associated with hyperfiltration and amplifies the age‐related eGFR decline.

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Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study

Cited by 333 publications

References 36 publications

From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

Differential risk of 23 site‐specific incident cancers and cancer‐related mortality among patients with metabolic dysfunction‐associated fatty liver disease: a population‐based cohort study with 9.7 million Korean subjects

MAFLD and glomerular hyperfiltration in subjects with normoglycemia, prediabetes and type 2 diabetes: A cross‐sectional population study

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