Younossi Zobair M, Paik James M, Al Shabeeb Reem, Golabi Pegah, Younossi Issah, Henry Linda
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
Hepatology. 2022 Nov;76(5):1423-1437. doi: 10.1002/hep.32499. Epub 2022 May 2.
Given the association of NAFLD with metabolic risks, a name change to MAFLD is proposed. We compared the long-term outcomes of NAFLD and MAFLD.
We included patients with fatty liver disease (FLD) from NHANES III and NHANES 2017-2018 (FLD defined as moderate to severe hepatic steatosis by ultrasound for NHANES III and as having a controlled attenuation parameter ≥285 dB/m for NHANES 2017-2018). NAFLD was defined as FLD without other liver diseases and excess alcohol use. Metabolic-associated fatty liver disease (MAFLD) was defined as FLD and metabolic dysfunction per criteria. All NHANES III participants had linked mortality data through December 31, 2015.
NHANES III participants (n = 12,878): mean age 43.1 years old; 49.5% male; 20.3% with FLD, 16.5% with NAFLD, and 18.1% with MAFLD. NHANES 2017-2018 participants (n = 4328): mean age 48.0 years old; 49.1% male; 36.8% with FLD, 34.2% with NAFLD, and 36.3% with MAFLD. Excellent concordance was noted between MAFLD and NAFLD diagnosis in both data sets (kappa coefficient = 0.83-0.94). Except for components of each definition (e.g., alcohol use for MAFLD), no other major differences in clinical characteristics were noted. During up to 27 years of follow-up (median of 22.8 years), no differences in cumulative all-cause and cause-specific mortality were noted. In addition to the stage of fibrosis, insulin resistance was a predictor of liver mortality in NAFLD, and alcohol-associated liver disease (ALD) was a predictor of mortality in MAFLD.
MAFLD and NAFLD have similar clinical profiles and long-term outcomes. The increased liver-related mortality among NAFLD is driven by insulin resistance, and among MAFLD is primarily driven by ALD.
鉴于非酒精性脂肪性肝病（NAFLD）与代谢风险相关，有人提议将其更名为代谢相关脂肪性肝病（MAFLD）。我们比较了NAFLD和MAFLD的长期预后。
我们纳入了来自美国国家健康与营养检查调查（NHANES）III和2017 - 2018年NHANES的脂肪肝疾病（FLD）患者（对于NHANES III，FLD定义为超声检查显示中度至重度肝脂肪变性；对于2017 - 2018年NHANES，定义为控制衰减参数≥285 dB/m）。NAFLD定义为无其他肝脏疾病且无过量饮酒的FLD。代谢相关脂肪性肝病（MAFLD）根据标准定义为FLD和代谢功能障碍。所有NHANES III参与者都有截至2015年12月31日的关联死亡率数据。
NHANES III参与者（n = 12,878）：平均年龄43.1岁；49.5%为男性；20.3%患有FLD，16.5%患有NAFLD，18.1%患有MAFLD。2017 - 2018年NHANES参与者（n = 4328）：平均年龄48.0岁；49.1%为男性；36.8%患有FLD，34.2%患有NAFLD，36.3%患有MAFLD。在两个数据集中，MAFLD和NAFLD诊断之间具有高度一致性（kappa系数 = 0.83 - 0.94）。除了每个定义的组成部分（例如，MAFLD中的饮酒情况）外，未发现临床特征有其他重大差异。在长达27年的随访（中位随访时间为22.8年）中，未发现累积全因死亡率和特定病因死亡率有差异。除了纤维化阶段外，胰岛素抵抗是NAFLD肝脏死亡率的预测因素，而酒精性肝病（ALD）是MAFLD死亡率的预测因素。
MAFLD和NAFLD具有相似的临床特征和长期预后。NAFLD中肝脏相关死亡率增加是由胰岛素抵抗驱动的，而MAFLD中主要由ALD驱动。
