Division of Gastroenterology and Hepatology, National University Hospital, Singapore 119228, Singapore.
Yong Loo Lin School of Medicine, Singapore 117597, Singapore.
World J Gastroenterol. 2023 Jan 21;29(3):549-560. doi: 10.3748/wjg.v29.i3.549.
BACKGROUND: In 2020, an international expert panel proposed a new definition of fatty liver: Metabolic dysfunction-associated fatty liver disease (MAFLD). The MAFLD added the criteria for defining metabolic dysfunctions, which are high-risk factors for liver-related and cardiovascular events. Contrary to the non-alcoholic fatty liver disease (NAFLD) definition, it allows the coexistence of MAFLD and significant alcohol use in the same patient. AIM: To review the existing data that evaluate the clinical profile and long-term outcome difference between the patients identified as MAFLD and NAFLD. METHODS: Databases MEDLINE PubMed and EMBASE were searched and relevant publications up to June 28, 2022 were assessed. Studies were included if they involved human participants diagnosed with MAFLD. RESULTS: A total of 2324 records were reviewed, of which 1575 duplicate citations were removed. Of the 2324 records screened, 207 articles were excluded, and 542 articles were assessed for their eligibility, for which 511 were excluded. The remaining 31 articles were selected for review. MAFLD diagnostic criteria were able to identify more individuals with fatty liver. Studies have shown that patients included using the MAFLD criteria were associated with higher risks of hepatic fibrosis when compared to NAFLD. All-cause mortality, cardiovascular disease-related, and cancer-related mortality were shown to be higher in MAFLD patients. MAFLD patients also had higher baseline metabolic derangement, and risks of developing obesity, diabetes, and cardiovascular events. Of the 3 subtypes, diabetes mellitus has the strongest association with negative outcomes, followed by metabolic dysfunction and elevated body mass index. Within the subtypes of MAFLD, patients with more metabolic conditions at the time of diagnosis had worse hepatic and liver injury compared to those with a single metabolic condition. CONCLUSION: MAFLD is a new definition of fatty liver disease that is gaining increasing acceptance. It is based on empirical clinical practice on positive inclusion of metabolic risk factors and recent evidence suggests that it helps to identify patients with higher risk for liver-related as well as cardiovascular events.
背景：2020 年，一个国际专家小组提出了脂肪肝的新定义：代谢相关脂肪性肝病（MAFLD）。MAFLD 增加了代谢功能障碍的定义标准，这些标准是与肝和心血管事件相关的高危因素。与非酒精性脂肪性肝病（NAFLD）的定义不同，它允许 MAFLD 和大量饮酒在同一患者中同时存在。
目的：回顾评估符合 MAFLD 和 NAFLD 诊断的患者临床特征和长期结局差异的现有数据。
方法：检索 MEDLINE、PubMed 和 EMBASE 数据库，并评估截至 2022 年 6 月 28 日的相关出版物。纳入涉及 MAFLD 诊断的人类参与者的研究。
结果：共回顾了 2324 条记录，其中去除了 1575 条重复引用。在 2324 条筛选的记录中，排除了 207 篇重复文章，评估了 542 篇文章的纳入资格，其中排除了 511 篇。剩余的 31 篇文章被选入综述。MAFLD 诊断标准能够识别更多患有脂肪肝的个体。研究表明，与 NAFLD 相比，使用 MAFLD 标准纳入的患者肝纤维化风险更高。MAFLD 患者的全因死亡率、心血管疾病相关死亡率和癌症相关死亡率更高。MAFLD 患者的基线代谢紊乱程度更高，发生肥胖、糖尿病和心血管事件的风险也更高。在 3 种亚型中，糖尿病与不良结局的相关性最强，其次是代谢功能障碍和体重指数升高。在 MAFLD 的亚型中，与仅存在一种代谢异常相比，诊断时存在更多代谢异常的患者的肝脏和肝损伤更严重。
结论：MAFLD 是一种新的脂肪肝定义，越来越被认可。它基于代谢危险因素的阳性纳入的经验性临床实践，最近的证据表明，它有助于识别与肝相关和心血管事件风险更高的患者。
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