Background & Aims

Recently, international experts proposed redefining non-alcoholic fatty liver disease (NAFLD) as metabolic dysfunction-associated fatty liver disease (MAFLD), based on modified criteria. It is suspected that outcomes such as mortality may differ for these clinical entities. We studied the impact of MAFLD and NAFLD on all-cause and cause-specific mortality in US adults.

Methods

We analyzed data from 7,761 participants in the Third National Health and Nutrition Examination Survey and their linked mortality through 2015. NAFLD was diagnosed by ultrasonographic evidence of hepatic steatosis without other known liver diseases. MAFLD was defined based on the criteria proposed by an international expert panel. The Cox proportional hazard model was used to study all-cause mortality and cause-specific mortality between MAFLD and NAFLD, with adjustments for known risk factors.

Results

During a median follow-up of 23 years, individuals with MAFLD had a 17% higher risk of all-cause mortality (hazard ratio [HR] 1.17; 95% CI 1.04-1.32). Furthermore, MAFLD was associated with a higher risk of cardiovascular mortality. NAFLD per se did not increase the risk of all-cause mortality. Individuals who met both definitions had a higher risk of all-cause mortality (HR 1.13, 95% CI 1.00-1.26), while individuals who met the definition for MAFLD but not NAFLD had a 1.7-fold higher risk of all-cause mortality (HR 1.66, 95% CI 1.19-2.32). Estimates for all-cause mortality were higher for those with advanced fibrosis and MAFLD than for those with advanced fibrosis and NAFLD.

Conclusions

In this US population-based study, MAFLD was associated with an increased risk of all-cause mortality, while NAFLD demonstrated no association with all-cause mortality after adjusting for metabolic risk factors.

Lay summary

Our findings provide further support for the idea that non-alcoholic fatty liver disease (NAFLD) is a part of a broader multi-system disease that also includes obesity, diabetes, high blood pressure, and high cholesterol. Therefore, re-defining NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD) may help improve our understanding of predictors that increase the risk of death.

中文翻译：

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在美国，代谢功能障碍相关的脂肪肝与全因死亡率增加有关

背景与目标

最近，国际专家提出基于修改后的标准，将非酒精性脂肪肝病（NAFLD）重新定义为代谢功能障碍相关的脂肪肝病（MAFLD）。怀疑这些临床实体的死亡率等结果可能不同。我们研究了 MAFLD 和 NAFLD 对美国成年人全因和特定原因死亡率的影响。

方法

我们分析了第三次全国健康和营养检查调查中 7,761 名参与者的数据及其到 2015 年的相关死亡率。NAFLD 是通过肝脏脂肪变性的超声证据诊断出来的，而没有其他已知的肝脏疾病。MAFLD 是根据一个国际专家小组提出的标准定义的。Cox 比例风险模型用于研究 MAFLD 和 NAFLD 之间的全因死亡率和特定原因死亡率，并对已知风险因素进行了调整。

结果

在 23 年的中位随访期间，MAFLD 个体的全因死亡风险高出 17%（风险比 [HR] 1.17；95% CI 1.04-1.32）。此外，MAFLD 与较高的心血管死亡风险相关。NAFLD本身并没有增加全因死亡的风险。满足这两个定义的个体全因死亡风险较高（HR 1.13, 95% CI 1.00-1.26），而满足MAFLD定义但不满足NAFLD的个体全因死亡风险高1.7倍。 HR 1.66, 95% CI 1.19-2.32)。晚期纤维化和 MAFLD 患者的全因死亡率估计值高于晚期纤维化和 NAFLD 患者。

结论

在这项基于美国人群的研究中，MAFLD 与全因死亡率风险增加相关，而在调整代谢风险因素后，NAFLD 与全因死亡率无关。

总结

我们的研究结果进一步支持了以下观点，即非酒精性脂肪性肝病 (NAFLD) 是更广泛的多系统疾病的一部分，该疾病还包括肥胖、糖尿病、高血压和高胆固醇。因此，将 NAFLD 重新定义为代谢功能障碍相关的脂肪肝疾病 (MAFLD) 可能有助于提高我们对增加死亡风险的预测因子的理解。