Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States.
Department of Medicine, Stanford University School of Medicine, Stanford, California, United States.
J Hepatol. 2021 Dec;75(6):1284-1291. doi: 10.1016/j.jhep.2021.07.035. Epub 2021 Aug 8.
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.
背景与目的：最近，国际专家提出根据改良标准，将非酒精性脂肪性肝病（NAFLD）重新定义为代谢相关脂肪性肝病（MAFLD）。据怀疑，这些临床实体的死亡率等结果可能不同。我们研究了 MAFLD 和 NAFLD 对美国成年人全因和特定原因死亡率的影响。
方法：我们分析了来自第三次全国健康和营养检查调查的 7761 名参与者及其通过 2015 年链接的死亡率数据。NAFLD 通过无其他已知肝脏疾病的超声证据诊断为肝脂肪变性。MAFLD 根据国际专家小组提出的标准定义。使用 Cox 比例风险模型研究 MAFLD 和 NAFLD 之间的全因死亡率和特定原因死亡率，并对已知危险因素进行调整。
结果：在中位数为 23 年的随访期间，MAFLD 患者全因死亡率的风险增加了 17%（风险比 [HR] 1.17；95%CI 1.04-1.32）。此外，MAFLD 与心血管死亡率升高相关。单纯的 NAFLD 并未增加全因死亡率的风险。符合两种定义的患者全因死亡率风险更高（HR 1.13，95%CI 1.00-1.26），而符合 MAFLD 定义但不符合 NAFLD 定义的患者全因死亡率风险增加 1.7 倍（HR 1.66，95%CI 1.19-2.32）。纤维化和 MAFLD 并存的患者的全因死亡率估计值高于纤维化和 NAFLD 并存的患者。
结论：在这项基于美国人群的研究中，MAFLD 与全因死亡率增加相关，而调整代谢危险因素后，NAFLD 与全因死亡率无关联。
简要结论：我们的研究结果进一步支持了这样一种观点，即非酒精性脂肪性肝病（NAFLD）是一种更广泛的多系统疾病的一部分，该疾病还包括肥胖、糖尿病、高血压和高胆固醇。因此，将 NAFLD 重新定义为代谢相关脂肪性肝病（MAFLD）可能有助于提高我们对增加死亡风险的预测因子的理解。
Aliment Pharmacol Ther. 2024-7
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