Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
Clin Gastroenterol Hepatol. 2021 Oct;19(10):2138-2147.e10. doi: 10.1016/j.cgh.2020.12.022. Epub 2020 Dec 22.
BACKGROUND & AIMS: An international expert panel proposed a new definition for metabolic dysfunction-associated fatty liver disease (MAFLD) as a name change from nonalcoholic fatty liver disease (NAFLD). The clinical impact of this change on the assessment of cardiovascular disease (CVD) risk is yet unknown. We evaluated the prevalence of fatty liver disease (FLD) and the associated CVD risk using each of these definitions.
From a nationwide health screening database, we included 9,584,399 participants (48.5% male) aged 40-64 years between 2009 and 2010. Participants were categorized by presence of NAFLD and MAFLD, separately, and by the combination of the 2 definitions-Neither-FLD, NAFLD-only, MAFLD-only, or Both-FLD. The primary outcome was a composite CVD event, including myocardial infarction, ischemic stroke, heart failure, or CVD-related death.
The prevalence of NAFLD and MAFLD was 28.0% and 37.3%, respectively. After excluding those with prior CVD, 8,962,813 participants were followed for a median of 10.1 years. NAFLD and MAFLD were each associated with significantly higher risk for CVD events. When the Neither-FLD group was the reference, multivariable-adjusted hazard ratios (95% confidence interval) for CVD events were 1.09 (1.03-1.15) in the NAFLD-only group, 1.43 (1.41-1.45) in the MAFLD-only group, and 1.56 (1.54-1.58) in the Both-FLD group.
A considerable proportion of middle-aged Korean adults have MAFLD without satisfying the former definition of NAFLD. The change from NAFLD to MAFLD criteria may identify a greater number of individuals with metabolically complicated fatty liver and increased risk for CVD.
一个国际专家小组提出了代谢功能相关脂肪性肝病（MAFLD）的新定义，将其命名从非酒精性脂肪性肝病（NAFLD）改为 MAFLD。这种变化对心血管疾病（CVD）风险评估的临床影响尚不清楚。我们使用这两种定义分别评估了脂肪肝疾病（FLD）的患病率和相关 CVD 风险。
我们从全国性健康筛查数据库中纳入了 9584399 名年龄在 40-64 岁之间（48.5%为男性）的参与者，他们在 2009 年至 2010 年期间接受了检查。参与者分别按照是否存在 NAFLD 和 MAFLD 以及这两种定义的组合进行分类，即无 FLD、仅 NAFLD、仅 MAFLD 或同时存在 FLD。主要结局是复合 CVD 事件，包括心肌梗死、缺血性卒中和心力衰竭或 CVD 相关死亡。
NAFLD 和 MAFLD 的患病率分别为 28.0%和 37.3%。在排除有既往 CVD 的患者后，对 8962813 名参与者进行了中位时间为 10.1 年的随访。NAFLD 和 MAFLD 均与 CVD 事件风险显著增加相关。当以无 FLD 组为参照时，多变量调整后的 CVD 事件危险比（95%置信区间）在仅 NAFLD 组为 1.09（1.03-1.15），在仅 MAFLD 组为 1.43（1.41-1.45），在同时存在 FLD 组为 1.56（1.54-1.58）。
相当一部分中年韩国成年人患有 MAFLD，但不符合以前的 NAFLD 定义。从 NAFLD 改为 MAFLD 标准可能会识别出更多代谢性复杂脂肪肝和 CVD 风险增加的个体。
