Outcomes of NAFLD and MAFLD: Results from a community-based, prospective cohort study

AbstractIntroductionMetabolic (dysfunction)-associated fatty liver disease (MAFLD) is a recently suggested alternative to Non-alcoholic fatty liver disease (NAFLD). We compared baseline metabolic traits and outcomes of NAFLD and MAFLD.MethodsIn an ongoing, community-based, cohort study, participants were first screened in 2007 by structured-interview, anthropometry, liver ultrasonography, and biochemical/serological tests and reassessed after 7-years. Baseline characteristics and outcomes after 7-years were compared in NAFLD and MAFLD, in those excluded by the NAFLD definition but captured by the MAFLD definition and those excluded by the MAFLD definition but captured by the NAFLD definition, versus controls.ResultsOf 2985 recruited in 2007, 940 (31.5%) had NAFLD, 990 (33.1%) had MAFLD and 362 (12.1%) were controls. Compared to NAFLD, MAFLD captured an additional 2.9% of individuals from the cohort and lost 1.3%. At baseline, anthropometric and metabolic traits were similar in NAFLD and MAFLD. At follow-up after 7 years, the odds of having new-onset metabolic traits and fatal/non-fatal CVEs were similar in the two groups, but were significantly higher in both the groups compared to controls. However, those excluded by the NAFLD definition but captured by the MAFLD definition, showed higher baseline metabolic derangements compared to those excluded by the MAFLD definition but captured by the NAFLD definition and had higher odds for having new onset metabolic traits and CVEs compared to controls.ConclusionEven though it was able to increase the index population by only a small proportion, redefining NAFLD as MAFLD seemed to improve clinical utility.Lay SummaryThe term “metabolic (dysfunction)-associated fatty liver disease (MAFLD)” has recently been suggested as an alternative to “non-alcoholic fatty liver disease (NAFLD)”.In our study, the diagnostic criteria for MAFLD detected a slightly higher number of individuals than NAFLD from the community.The proportions of anthropometric and metabolic abnormalities in NAFLD and MAFLD were similar. The adverse outcomes of NAFLD and MAFLD were also similar, but were worse than in a population without NAFLD or MAFLD.Those who were excluded by the NAFLD definition and captured by the MAFLD definition seem to be at higher risk of adverse outcomes than those excluded by the MAFLD definition but captured by the NAFLD definition.Although it was able to increase the index population by only a small proportion, redefining NAFLD as MAFLD seems useful.