. 2023 Aug;17(4):773-791.

doi: 10.1007/s12072-023-10543-8. Epub 2023 May 19.

An international multidisciplinary consensus statement on MAFLD and the risk of CVD

Xiao-Dong Zhou^#¹, Giovanni Targher^#², Christopher D Byrne^#³, Virend Somers⁴, Seung Up Kim⁵, C Anwar A Chahal^{4

6

7}, Vincent Wai-Sun Wong⁸, Jingjing Cai⁹, Michael D Shapiro¹⁰, Mohammed Eslam¹¹, Philippe Gabriel Steg¹², Ki-Chul Sung¹³, Anoop Misra¹⁴, Jian-Jun Li¹⁵, Carlos Brotons¹⁶, Yuli Huang¹⁷, George V Papatheodoridis¹⁸, Aijun Sun¹⁹, Yusuf Yilmaz^{20

21}, Wah Kheong Chan²², Hui Huang²³, Nahum Méndez-Sánchez²⁴, Saleh A Alqahtani^{25

26}, Helena Cortez-Pinto²⁷, Gregory Y H Lip^{28

29}, Robert J de Knegt³⁰, Ponsiano Ocama³¹, Manuel Romero-Gomez³², Marat Fudim^{33

34}, Giada Sebastiani³⁵, Jang Won Son³⁶, John D Ryan³⁷, Ignatios Ikonomidis³⁸, Sombat Treeprasertsuk³⁹, Daniele Pastori⁴⁰, Monica Lupsor-Platon⁴¹, Herbert Tilg⁴², Hasmik Ghazinyan⁴³, Jerome Boursier^{44

45}, Masahide Hamaguchi⁴⁶, Mindie H Nguyen^{47

48}, Jian-Gao Fan⁴⁹, George Boon-Bee Goh⁵⁰, Mamun Al Mahtab⁵¹, Saeed Hamid⁵², Nilanka Perera⁵³, Jacob George⁵⁴, Ming-Hua Zheng^{55

56

57}

Affiliations

¹ Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
² Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy.
³ Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK.
⁴ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA.
⁵ Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
⁶ Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA.
⁷ Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, West Smithfield, UK.
⁸ State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
⁹ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
¹⁰ Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
¹¹ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia.
¹² Université Paris -Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.
¹³ Department of Internal Medicine, Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁴ Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, National Diabetes Obesity and Cholesterol Foundation and Diabetes Foundation (India), New Delhi, India.
¹⁵ State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁶ Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain.
¹⁷ Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road, Lunjiao Town, Shunde District, Foshan, China.
¹⁸ Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
¹⁹ Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
²¹ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
²² Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²³ Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, China.
²⁴ Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
²⁵ Liver Transplantation Unit, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
²⁶ Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA.
²⁷ Laboratório de Nutrição e Metabolismo, Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisbon, Portugal.
²⁸ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
²⁹ Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³⁰ Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Gravendijkwal 230, Room Ha 206, Rotterdam, The Netherlands.
³¹ Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
³² Department of Digestive and Liver Diseases, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, University of Seville, Seville, Spain.
³³ Department of Cardiology, Duke University School of Medicine, Durham, NC, USA.
³⁴ Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
³⁵ Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, 1001 Blvd. Décarie, Montreal, Canada.
³⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
³⁷ Department of Hepatology, RCSI School of Medicine and Medical Sciences, Dublin/Beaumont Hospital, Dublin, Ireland.
³⁸ Preventive Cardiology Laboratory and Cardiometabolic Clinic, Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
³⁹ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
⁴⁰ Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
⁴¹ Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁴² Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.
⁴³ Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia.
⁴⁴ Hepato-Gastroenterology Department, University Hospital, 4 Larrey Street, 49933, Angers Cedex 09, France.
⁴⁵ HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France.
⁴⁶ Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Japan.
⁴⁷ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
⁴⁸ Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA.
⁴⁹ Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵⁰ Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
⁵¹ Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
⁵² Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
⁵³ Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
⁵⁴ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia. jacob.george@sydney.edu.au.
⁵⁵ MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. zhengmh@wmu.edu.cn.
⁵⁶ Institute of Hepatology, Wenzhou Medical University, Wenzhou, China. zhengmh@wmu.edu.cn.
⁵⁷ Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China. zhengmh@wmu.edu.cn.

^# Contributed equally.

PMID: 37204656
PMCID: PMC10198034
DOI: 10.1007/s12072-023-10543-8

An international multidisciplinary consensus statement on MAFLD and the risk of CVD

Xiao-Dong Zhou et al. Hepatol Int. 2023 Aug.

. 2023 Aug;17(4):773-791.

doi: 10.1007/s12072-023-10543-8. Epub 2023 May 19.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
² Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy.
³ Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK.
⁴ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA.
⁵ Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
⁶ Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA.
⁷ Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, West Smithfield, UK.
⁸ State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
⁹ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
¹⁰ Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
¹¹ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia.
¹² Université Paris -Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.
¹³ Department of Internal Medicine, Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁴ Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, National Diabetes Obesity and Cholesterol Foundation and Diabetes Foundation (India), New Delhi, India.
¹⁵ State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁶ Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain.
¹⁷ Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road, Lunjiao Town, Shunde District, Foshan, China.
¹⁸ Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
¹⁹ Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
²¹ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
²² Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²³ Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, China.
²⁴ Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
²⁵ Liver Transplantation Unit, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
²⁶ Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA.
²⁷ Laboratório de Nutrição e Metabolismo, Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisbon, Portugal.
²⁸ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
²⁹ Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³⁰ Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Gravendijkwal 230, Room Ha 206, Rotterdam, The Netherlands.
³¹ Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
³² Department of Digestive and Liver Diseases, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, University of Seville, Seville, Spain.
³³ Department of Cardiology, Duke University School of Medicine, Durham, NC, USA.
³⁴ Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
³⁵ Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, 1001 Blvd. Décarie, Montreal, Canada.
³⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
³⁷ Department of Hepatology, RCSI School of Medicine and Medical Sciences, Dublin/Beaumont Hospital, Dublin, Ireland.
³⁸ Preventive Cardiology Laboratory and Cardiometabolic Clinic, Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
³⁹ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
⁴⁰ Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
⁴¹ Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁴² Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.
⁴³ Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia.
⁴⁴ Hepato-Gastroenterology Department, University Hospital, 4 Larrey Street, 49933, Angers Cedex 09, France.
⁴⁵ HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France.
⁴⁶ Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Japan.
⁴⁷ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
⁴⁸ Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA.
⁴⁹ Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵⁰ Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
⁵¹ Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
⁵² Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
⁵³ Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
⁵⁴ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia. jacob.george@sydney.edu.au.
⁵⁵ MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. zhengmh@wmu.edu.cn.
⁵⁶ Institute of Hepatology, Wenzhou Medical University, Wenzhou, China. zhengmh@wmu.edu.cn.
⁵⁷ Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China. zhengmh@wmu.edu.cn.

^# Contributed equally.

PMID: 37204656
PMCID: PMC10198034
DOI: 10.1007/s12072-023-10543-8

Abstract

Background: Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25-30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists.

Methods and results: A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management.

Conculsions: The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research.

Keywords: Cardiovascular disease; Consensus; Delphi survey; MAFLD; Metabolic (dysfunction)-associated fatty liver disease; Non-alcoholic fatty liver disease.

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Conflict of interest statement

George V Papatheodoridis: Advisor: Abbvie, Albireo, Amgen, Dicerna, Gilead, GlaxoSmithKline, Ipsen, Janssen, Novo Nordisk, Roche and Takeda; Lectures: Abbvie, Gilead, GlaxoSmithKline, Ipsen, Novo Nordisk, Sobi; Research grants: Abbvie, Gilead; Investigator in clinical trials: Abbvie, Astellas, Bayer, Eiger, Gilead, GlaxoSmithKline, Janssen, Merck Sharp & Dohme, Noorik, Novartis, Novo Nordisk, Regulus, Roche, Takeda. Giada Sebastiani: Speaker: Merck, Gilead, Abbvie, Novonordisk, Novartis and Pfizer; Advisory board member: Pfizer, Merck, Novonordisk, Gilead and Intercept; Unrestricted research funding: Theratecnologies Inc. Gregory Y. H. Lip: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthem. No fees are received personally. GYHL is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871. Jian-Gao Fan: Speaker, a consultant and an advisory for Sanofi, Abbott, EchoSens, Novartis, Hisky, Gilead, Allergan, Terns and MADAUS GMBH. John D. Ryan: None related to MAFLD. Consulting: Bond Biosciences, Pfizer, Gilead; Lectures: Kyowa kirin, Falk. Marat Fudim: Dr Fudim was supported by Bayer. He receives consulting fees from Bayer, Merck, NovoNordisk. Michael D. Shapiro: Research Grants (paid to my institution): AHA, NIH, Amgen, Novartis, Ionis, Esperion; Consultant: Ionis, Novartis, Regeneron; Scientific Advisory Boards: Amgen, Novartis, Precision Bioscience. Mindie H. Nguyen: Last 36 months: Research support: Pfizer, Enanta, Astra Zeneca, Innogen, Exact Science, CurveBio, Delfi Biotech, Gilead, Exact Sciences, Vir Biotech, Helio Health, National Cancer Institute, Glycotest, B.K. Kee Foundation. Consulting and/or Advisory Board: Intercept, Exact Science, Gilead, GSK, Eli Lilly, Laboratory of Advanced Medicine, Exelixis Research grants. Ming-Hua Zheng: Lectures: Hisky Medical. Philippe Gabriel Steg: Research grants: Amarin, Bayer, Sanofi, and Servier; Clinical Trials (Steering committee, CEC, DSMB): Amarin, AstraZeneca, Bayer, Bristol-Myers Squibb, Idorsia, Novartis, PhaseBio, Pfizer, Sanofi, Servier; Consulting or speaking: Amarin, Amgen, BMS/Myokardia, Merck, Novo-Nordisk, Regeneron; Senior Associate Editor at Circulation. Seung Up Kim: He has served as an advisory committee member Gilead Sciences, Bayer, Eisai, and Novo Nordisk. He is a speaker for Gilead Sciences, GSK, Bayer, Eisai, Abbvie, EchoSens, MSD, Eisai, Otsuka, and Bristol-Myers Squibb. He has also received a research grant from Abbvie and Bristol-Myers Squibb. Vincent Wai-Sun Wong: Consultancy: AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Novo Nordisk, Pfizer, Sagimet Biosciences, TARGET PharmaSolutions; Lectures: Abbott, AbbVie, Gilead Sciences, Novo Nordisk; Research grants: Gilead Sciences; Stock: Co-founder of Illuminatio Medical Technology Limited. Wah Kheong Chan: Consultant or advisory board member for Roche, Abbvie, Boehringer Ingelheim and Novo Nordisk; speaker for Viatris and Hisky Medical. Yusuf Yilmaz: He has served as consultant to Cymabay, Zydus, Novo Nordisk, and Echosens. The other authors have no conflicts of interest to declare.

Figures

**Fig. 1**
Flowchart of the Delphi procedure adopted for developing a consensus statement on MAFLD and risk of CVD

**Fig. 2**
Proportion of experts replying "agree" by experts in Round 1 and Round 2 (a); and total proportion of experts replying "agree or somewhat agree" by experts in Round 1 and Round 2 (b)

See this image and copyright information in PMC

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An international multidisciplinary consensus statement on MAFLD and the risk of CVD

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An international multidisciplinary consensus statement on MAFLD and the risk of CVD

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