Metabolic dysfunction-associated fatty liver disease is associated with increased all-cause mortality in the United States
- PMID: 34380057
- DOI: 10.1016/j.jhep.2021.07.035
Metabolic dysfunction-associated fatty liver disease is associated with increased all-cause mortality in the United States
Abstract
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.
Keywords: NHANES; cardiovascular; death; hepatic steatosis; malignancy.
Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Conflict of interest statement
Conflict of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.
Comment in
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Prognosis of MAFLD vs. NAFLD and implications for a nomenclature change.J Hepatol. 2021 Dec;75(6):1267-1270. doi: 10.1016/j.jhep.2021.08.020. Epub 2021 Aug 28. J Hepatol. 2021. PMID: 34464658 No abstract available.
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NAFLD vs. MAFLD - It is not the name but the disease that decides the outcome in fatty liver.J Hepatol. 2022 Feb;76(2):475-477. doi: 10.1016/j.jhep.2021.09.002. Epub 2021 Sep 14. J Hepatol. 2022. PMID: 34530064 No abstract available.
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One not like the other: The weakness of the blood sugar-MAFLD analogy.J Hepatol. 2022 Feb;76(2):482-484. doi: 10.1016/j.jhep.2021.10.010. Epub 2021 Oct 20. J Hepatol. 2022. PMID: 34678406 No abstract available.
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Reply to: "NAFLD vs. MAFLD - It is not the name but the disease that decides the outcome in fatty liver".J Hepatol. 2022 Feb;76(2):477-478. doi: 10.1016/j.jhep.2021.10.023. Epub 2021 Nov 5. J Hepatol. 2022. PMID: 34748894 No abstract available.
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A simpler definition of MAFLD better predicts long-term all-cause mortality in American adults.J Hepatol. 2022 Sep;77(3):877-879. doi: 10.1016/j.jhep.2022.01.015. Epub 2022 Feb 1. J Hepatol. 2022. PMID: 35121077 No abstract available.
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Metabolic dysfunction-associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD): distinct fatty liver entities with different clinical outcomes?Hepatobiliary Surg Nutr. 2022 Apr;11(2):299-301. doi: 10.21037/hbsn-21-548. Hepatobiliary Surg Nutr. 2022. PMID: 35464288 Free PMC article. No abstract available.
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NAFLD or MAFLD: the data behind the debate.Hepatobiliary Surg Nutr. 2022 Jun;11(3):439-442. doi: 10.21037/hbsn-2022-07. Hepatobiliary Surg Nutr. 2022. PMID: 35693413 Free PMC article. No abstract available.
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