Huang Qi, Zou Xiantong, Wen Xin, Zhou Xianghai, Ji Linong
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Front Med (Lausanne). 2021 Jul 1;8:693507. doi: 10.3389/fmed.2021.693507. eCollection 2021.
The recent change of terminology from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) has raised heated discussion. We aim to investigate the association of MAFLD or NAFLD with all-cause and cause-specific mortality to compare the outcomes of the two diagnostic criteria in population-based study. We recruited 12,480 participants from the Third National Health and Nutrition Examination Survey (NHANES III) with matched mortality data in 2015. Participants were divided into four groups for survival analysis: without NAFLD or MAFLD, with only NAFLD, only MAFLD. Cox proportional hazard regression was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality. Subgroup analysis were applied in MAFLD patients. The weighted prevalence of MAFLD and NAFLD was relatively 27.4 and 27.9%. Participants with NAFLD or MAFLD were largely overlapped (weighted Cohen's kappa coefficient 0.76). MAFLD increased the overall risk for total mortality in a greater magnitude than NAFLD [HR 2.07 (95% CI 1.86, 2.29) vs. 1.47 (1.20, 1.79)], However, the difference was non-significant after metabolic parameters were adjusted. Risks for cardiovascular, neoplasm, and diabetes-related mortality were similar between MAFLD and NAFLD. Referring to individuals without both NAFLD and MAFLD, individuals with only NAFLD showed reduced total mortality [HR 0.48 (0.34, 0.68)] and neoplasm mortality [HR 0.46 (0.24, 0.89)] in crude. Nevertheless, individuals with only MAFLD independently increased the risk for total mortality [adjusted HR 1.47 (1.22, 1.77)] and neoplasm mortality [aHR 1.58 (1.09, 2.28)]. The risk for overall mortality in MAFLD was consistent between subgroups except for race-ethnicity and whether secondary to viral hepatitis. Participants with MAFLD or NAFLD were highly concordant. MAFLD showed greater risk for all-cause mortality and equal risk for cause-specific mortality referring to NAFLD. The new terminology excluded participants with lower mortality risk and included participants with higher risk. Drug development for MAFLD should consider ethnic differences.
近期术语从非酒精性脂肪性肝病（NAFLD）变更为代谢功能障碍相关脂肪性肝病（MAFLD）引发了激烈讨论。我们旨在研究MAFLD或NAFLD与全因死亡率和特定病因死亡率之间的关联，以便在基于人群的研究中比较这两种诊断标准的结果。我们从第三次全国健康和营养检查调查（NHANES III）中招募了12480名参与者，并获取了他们2015年匹配的死亡率数据。参与者被分为四组进行生存分析：无NAFLD或MAFLD、仅患有NAFLD、仅患有MAFLD。采用Cox比例风险回归来估计全因死亡率和特定病因死亡率的多变量调整风险比（HR）及95%置信区间（CI）。对MAFLD患者进行亚组分析。MAFLD和NAFLD的加权患病率分别为27.4%和27.9%。患有NAFLD或MAFLD的参与者在很大程度上重叠（加权科恩kappa系数为0.76）。与NAFLD相比，MAFLD使全因死亡的总体风险增加幅度更大[HR 2.07（95%CI 1.86，2.29）对1.47（1.20，1.79）]，然而，在调整代谢参数后，差异无统计学意义。MAFLD和NAFLD在心血管、肿瘤和糖尿病相关死亡率方面的风险相似。与既无NAFLD也无MAFLD的个体相比，仅患有NAFLD的个体在粗死亡率方面显示出全因死亡率降低[HR 0.48（0.34，0.68）]和肿瘤死亡率降低[HR 0.46（0.24，0.89）]。然而，仅患有MAFLD的个体独立增加了全因死亡率风险[调整后HR 1.47（1.22，1.77）]和肿瘤死亡率风险[aHR 1.58（1.09，2.28）]。除种族和是否继发于病毒性肝炎外，MAFLD患者亚组间的总体死亡风险一致。患有MAFLD或NAFLD的参与者高度一致。与NAFLD相比，MAFLD显示出更高的全因死亡风险和相同的特定病因死亡风险。新术语排除了死亡风险较低的参与者，纳入了风险较高的参与者。MAFLD的药物研发应考虑种族差异。
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