Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yongin Severance Hospital, Yongin, Korea.
Gut Liver. 2023 Jul 15;17(4):610-619. doi: 10.5009/gnl220400. Epub 2023 Feb 17.
BACKGROUND/AIMS: Metabolic dysfunction-associated fatty liver disease (MAFLD) is categorized into three subtypes: overweight/obese (OW), lean/normal weight with metabolic abnormalities, and diabetes mellitus (DM). We investigated whether fibrotic burden in liver differs across subtypes of MAFLD patients.
This cross-sectional multicenter study was done in cohorts of subjects who underwent a comprehensive medical health checkup between January 2014 and December 2020. A total of 42,651 patients with ultrasound-diagnosed fatty liver were included. Patients were classified as no MAFLD, OW-MAFLD, lean-MAFLD, and DM-MAFLD. Advanced liver fibrosis was defined based on the nonalcoholic fatty liver disease fibrosis score (NFS) or fibrosis-4 (FIB-4) index.
The mean age of the patients was 50.0 years, and 74.1% were male. The proportion of patients with NFS-defined advanced liver fibrosis was the highest in DM-MAFLD (6.6%), followed by OW-MAFLD (2.0%), lean-MAFLD (1.3%), and no MAFLD (0.2%). The proportion of patients with FIB-4-defined advanced liver fibrosis was the highest in DM-MAFLD (8.6%), followed by lean-MAFLD (3.9%), OW-MAFLD (3.0%), and no MAFLD (2.0%). With the no MAFLD group as reference, the adjusted odds ratios (95% confidence intervals) for NFS-defined advanced liver fibrosis were 4.46 (2.09 to 9.51), 2.81 (1.12 to 6.39), and 9.52 (4.46 to 20.36) in OW-MAFLD, lean-MAFLD, and DM-MAFLD, respectively, and the adjusted odds ratios for FIB-4-defined advanced liver fibrosis were 1.03 (0.78 to 1.36), 1.14 (0.82 to 1.57), and 1.97 (1.48 to 2.62) in OW-MAFLD, lean-MAFLD, and DM-MAFLD.
Fibrotic burden in the liver differs across MAFLD subtypes. Optimized surveillance strategies and therapeutic options might be needed for different MAFLD subtypes.
背景/目的：代谢相关脂肪性肝病（MAFLD）分为三种亚型：超重/肥胖（OW）、代谢异常的消瘦/正常体重和糖尿病（DM）。我们研究了不同 MAFLD 患者亚型之间肝纤维化负担是否存在差异。
这是一项横断面多中心研究，纳入了 2014 年 1 月至 2020 年 12 月期间接受全面医疗健康检查的队列中的受试者。共有 42651 名超声诊断为脂肪肝的患者纳入研究。患者分为非 MAFLD、OW-MAFLD、消瘦-MAFLD 和 DM-MAFLD。根据非酒精性脂肪性肝病纤维化评分（NFS）或纤维化-4 指数（FIB-4）定义为晚期纤维化。
患者的平均年龄为 50.0 岁，74.1%为男性。根据 NFS 定义的晚期肝纤维化患者比例最高的是 DM-MAFLD（6.6%），其次是 OW-MAFLD（2.0%）、消瘦-MAFLD（1.3%）和非 MAFLD（0.2%）。根据 FIB-4 定义的晚期肝纤维化患者比例最高的是 DM-MAFLD（8.6%），其次是消瘦-MAFLD（3.9%）、OW-MAFLD（3.0%）和非 MAFLD（2.0%）。以非 MAFLD 组为参照，OW-MAFLD、消瘦-MAFLD 和 DM-MAFLD 患者中 NFS 定义的晚期肝纤维化的调整比值比（95%置信区间）分别为 4.46（2.09 至 9.51）、2.81（1.12 至 6.39）和 9.52（4.46 至 20.36），FIB-4 定义的晚期肝纤维化的调整比值比分别为 1.03（0.78 至 1.36）、1.14（0.82 至 1.57）和 1.97（1.48 至 2.62）。
不同 MAFLD 亚型之间肝纤维化负担存在差异。可能需要针对不同的 MAFLD 亚型制定优化的监测策略和治疗选择。
