Non-Alcoholic Fatty Liver Disease Without Metabolic Associated Fatty Liver Disease and the Risk of Metabolic Syndrome,Clinical Gastroenterology and Hepatology

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Non-Alcoholic Fatty Liver Disease Without Metabolic Associated Fatty Liver Disease and the Risk of Metabolic Syndrome
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2022-09-22 , DOI: 10.1016/j.cgh.2022.09.014
Dong Hyun Sinn ₁ , Danbee Kang ₂ , Sung Chul Choi ₃ , Yun Soo Hong ₄ , Di Zhao ₄ , Eliseo Guallar ₅ , Yewan Park ₆ , Juhee Cho ₇ , Geum-Youn Gwak ₈

Affiliation

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

BACKGROUND & AIMS

Metabolic (dysfunction) associated fatty liver disease (MAFLD) was proposed to replace non-alcoholic fatty liver (NAFLD). Some people fulfill diagnostic criteria of NAFLD but not MAFLD (NAFLD without MAFLD), but the clinical implications of NAFLD in these subjects is unknown.

METHODS

We followed cohort of 12,197 men and women 20 years of age or older without metabolic dysfunction (defined by MAFLD criteria), heavy alcohol use, chronic viral hepatitis, liver cirrhosis or malignancy for their risk of incident metabolic syndrome defined by ATP III criteria.

RESULTS

By design, none of the study participants had MAFLD at baseline. The prevalence of NAFLD among participants without metabolic dysfunction meeting MAFLD criteria and without significant alcohol intake was 7.6%. During 74,508 person-years of follow-up, 2,179 participants developed metabolic syndrome. The fully adjusted hazard ratio for metabolic syndrome comparing participants with NAFLD to those without it was 1.61 (95% confidence interval, 1.42,1.83). The increased risk of incident metabolic syndrome associated with NAFLD persisted for all studied subgroups, and the association was stronger for those with increased waist circumference (p for interaction = 0.029) and those without elevated triglycerides levels (p for interaction = 0.047).

CONCLUSION

In this large cohort, participants with NAFLD without MAFLD were at higher risk of developing metabolic syndrome compared to participants with no NAFLD and no MAFLD. Using MAFLD criteria may miss opportunities for early intervention in these subjects.

中文翻译：

不伴有代谢相关脂肪肝的非酒精性脂肪肝以及代谢综合征的风险

背景与目标

建议代谢（功能障碍）相关脂肪肝（MAFLD）取代非酒精性脂肪肝（NAFLD）。有些人符合 NAFLD 但不符合 MAFLD（无 MAFLD 的 NAFLD）诊断标准，但 NAFLD 在这些受试者中的临床意义尚不清楚。

方法

我们对 12,197 名 20 岁或以上的男性和女性进行了随访，这些男性和女性没有代谢功能障碍（根据 MAFLD 标准定义）、酗酒、慢性病毒性肝炎、肝硬化或恶性肿瘤，以了解他们发生 ATP III 标准定义的代谢综合征的风险。

结果

根据设计，研究参与者在基线时均未患有 MAFLD。在没有符合 MAFLD 标准的代谢功能障碍且没有大量饮酒的参与者中，NAFLD 的患病率为 7.6%。在 74,508 人年的随访中，2,179 名参与者出现了代谢综合征。将患有 NAFLD 的参与者与未患有 NAFLD 的参与者进行完全调整后的代谢综合征风险比为 1.61（95% 置信区间，1.42，1.83）。在所有研究的亚组中，与 NAFLD 相关的代谢综合征风险增加持续存在，并且对于腰围增加的亚组（交互作用p = 0.029）和甘油三酯水平不升高的亚组（交互作用p = 0.047），这种关联更强。