Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China.
Hepatol Int. 2022 Aug;16(4):835-845. doi: 10.1007/s12072-022-10362-3. Epub 2022 Jun 14.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a newly proposed definition of fatty liver disease (FLD) independent of excessive alcohol consumption (EAC) and hepatitis viral infection. Evidence on the mortality risk in different types of FLD [nonalcoholic FLD (NAFLD), alcoholic FLD (AFLD), and MAFLD] is sparse, hindering the identification of high-risk populations for preferential clinical surveillance.
A total of 11,000 participants in the Third National Health and Nutrition Examination Survey were enrolled. Participants were categorized into three groups [FLD( - ), MAFLD( - ), and MAFLD( +)] according to FLD and MAFLD criteria, and further categorized into six groups by EAC. Multivariate Cox proportional hazard model was used to estimate the risk of all-cause, cardiovascular-related, and cancer-related mortality.
During a median follow-up of 23.2 years, a total of 3240 deaths were identified. Compared with FLD( - )/EAC( - ) participants, MAFLD( +) individuals had higher all-cause mortality risk [hazard ratio (HR) = 1.28, 95% confidence interval (CI) = 1.18-1.39] regardless of EAC status [MAFLD( +)/NAFLD: HR = 1.22, 95%CI = 1.11-1.34; MAFLD( +)/AFLD: HR = 1.83, 95%CI = 1.46-2.28], while not for MAFLD( - ) individuals. Furthermore, diabetes-driven-MAFLD had higher mortality risk (HR = 2.00, 95%CI = 1.77-2.27) followed by metabolic dysregulation-driven-MAFLD (HR = 1.30, 95%CI = 1.06-1.60) and overweight/obesity-driven-MAFLD (HR = 1.11, 95%CI = 1.00-1.22). Additionally, MAFLD( - ) participants with elevated fibrosis score were also associated with statistically significantly higher mortality risk (HR = 3.23, 95%CI = 1.63-6.40).
Utilizing a representative sample of the US population, we proved the validity of MAFLD subtype and fibrosis score, rather than the traditional definition (NAFLD and AFLD), in the risk stratification of FLD patients. These findings may be applied to guide the determination of surveillance options for FLD patients.
代谢相关脂肪性肝病（MAFLD）是一种新提出的与过量饮酒（EAC）和肝炎病毒感染无关的脂肪肝疾病（FLD）的定义。关于不同类型的 FLD[非酒精性 FLD（NAFLD）、酒精性 FLD（AFLD）和 MAFLD]的死亡率风险的证据很少，这阻碍了高风险人群的识别，以便进行优先临床监测。
共纳入第三次全国健康和营养检查调查中的 11000 名参与者。根据 FLD 和 MAFLD 标准，参与者被分为三组[FLD（-）、MAFLD（-）和 MAFLD（+）]，并根据 EAC 进一步分为六组。多变量 Cox 比例风险模型用于估计全因、心血管相关和癌症相关死亡率的风险。
在中位随访 23.2 年后，共确定了 3240 例死亡。与 FLD（-）/EAC（-）参与者相比，无论 EAC 状态如何，MAFLD（+）个体的全因死亡率风险更高[风险比（HR）=1.28，95%置信区间（CI）=1.18-1.39] [MAFLD（+）/NAFLD：HR=1.22，95%CI=1.11-1.34；MAFLD（+）/AFLD：HR=1.83，95%CI=1.46-2.28]，而 MAFLD（-）个体则没有。此外，糖尿病驱动的 MAFLD 死亡率风险更高（HR=2.00，95%CI=1.77-2.27），其次是代谢失调驱动的 MAFLD（HR=1.30，95%CI=1.06-1.60）和超重/肥胖驱动的 MAFLD（HR=1.11，95%CI=1.00-1.22）。此外，MAFLD（-）伴有升高的纤维化评分的患者也与统计学上显著更高的死亡率风险相关（HR=3.23，95%CI=1.63-6.40）。
利用美国代表性人群样本，我们证明了 MAFLD 亚型和纤维化评分的有效性，而不是传统的定义（NAFLD 和 AFLD），在 FLD 患者的风险分层中。这些发现可能适用于指导 FLD 患者的监测方案的确定。
