Tsutsumi Tsubasa, Eslam Mohammed, Kawaguchi Takumi, Yamamura Sakura, Kawaguchi Atsushi, Nakano Dan, Koseki Masahiro, Yoshinaga Shinobu, Takahashi Hirokazu, Anzai Keizo, George Jacob, Torimura Takuji
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia.
Hepatol Res. 2021 Nov;51(11):1115-1128. doi: 10.1111/hepr.13685. Epub 2021 Jul 2.
Metabolic associated fatty liver disease (MAFLD) partly overlaps with non-alcoholic fatty liver disease (NAFLD). Thus, using a generalized estimating equation (GEE) approach, we aimed to investigate the difference in worsening of atherosclerotic cardiovascular disease (ASCVD) risk between patients with MAFLD and NAFLD. We also investigated factors related to the difference between the two groups.
We enrolled 2306 subjects with fatty liver (MAFLD 80.7%, NAFLD 63.4%). Subjects with MAFLD/NAFLD were sub-classified into three groups: NAFLD with no metabolic dysfunction (non-Met NAFLD), overlapping, and MAFLD with moderate alcohol consumption (mod-Alc MAFLD). ASCVD risk was estimated by non-invasive tests, including the Suita score. An event was defined as worsening of these scores from the low-risk to the high-risk group. Independent factors for the event were analyzed by Cox regression analysis with the GEE.
In Cox regression analysis, MAFLD (HR 1.08, 95% CI 1.02-1.15, p = 0.014) and alcohol consumption (20-39 g/day; HR 1.73, 95% CI 1.26-2.36, p = 0.001) were independently associated with worsening of the Suita score. In a subanalysis, the incidence of the event was significantly lower in non-Met NAFLD than in the overlapping group (HR 0.70, 95% CI 0.50-0.98, p = 0.042). However, no significant difference was observed in the incidence between the overlapping and mod-Alc MAFLD group (HR 1.19, 95% CI 0.89-1.58, p = 0.235).
The GEE approach demonstrates that MAFLD better identifies patients with worsening of ASCVD risk than NAFLD. Moreover, the superiority of MAFLD over NAFLD was due to the presence of metabolic dysfunction rather than moderate alcohol consumption.
代谢相关脂肪性肝病（MAFLD）与非酒精性脂肪性肝病（NAFLD）部分重叠。因此，我们采用广义估计方程（GEE）方法，旨在研究MAFLD患者与NAFLD患者动脉粥样硬化性心血管疾病（ASCVD）风险恶化的差异。我们还研究了与两组差异相关的因素。
我们纳入了2306例脂肪肝患者（MAFLD占80.7%，NAFLD占63.4%）。MAFLD/NAFLD患者被分为三组：无代谢功能障碍的NAFLD（非代谢性NAFLD）、重叠组以及中度饮酒的MAFLD（中度饮酒MAFLD）。通过非侵入性检测评估ASCVD风险，包括Suita评分。事件定义为这些评分从低风险组恶化至高风险组。采用GEE的Cox回归分析事件的独立因素。
在Cox回归分析中，MAFLD（风险比[HR]1.08，95%置信区间[CI]1.02 - 1.15，p = 0.014）和饮酒（20 - 39克/天；HR 1.73，95% CI 1.26 - 2.36，p = 0.001）与Suita评分恶化独立相关。在亚组分析中，非代谢性NAFLD事件发生率显著低于重叠组（HR 0.70，95% CI 0.50 - 0.98，p = 0.042）。然而，重叠组与中度饮酒MAFLD组之间的发生率未观察到显著差异（HR 1.19，95% CI 0.89 - 1.58，p = 0.235）。
GEE方法表明，与NAFLD相比，MAFLD能更好地识别ASCVD风险恶化的患者。此外，MAFLD优于NAFLD的原因是存在代谢功能障碍，而非中度饮酒。
