Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
Hepatol Int. 2023 Jun;17(3):626-635. doi: 10.1007/s12072-023-10517-w. Epub 2023 Apr 17.
Changing terminology of non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) is recently proposed by expert panels based on metabolic dysregulations. However, clinical evidences for the risk of cardiovascular disease (CVD) in MAFLD are limited. The aim of this study is evaluating the association of cardiovascular risk in these two terminology and subgroups of MAFLD.
A total of 2133 individuals who underwent ultrasound and cardiac computed tomography contemporaneously were included at a single medical checkup center. Ultrasound was used to define fatty liver, and coronary artery calcification (CAC) defined a coronary artery calcium score above 0 was used to estimate the cardiovascular risk.
Overall, 911 participants were diagnosed with fatty liver. In the unadjusted analysis, NAFLD (OR = 1.4, 95% confidence interval [CI] = 1.05-1.85, p = 0.019) and MAFLD (OR = 1.55, 95% CI = 1.29-1.86, p = 0.046) were significantly associated with CAC. However, in sex and age-adjusted analyses, only MAFLD was associated with CAC (adjusted OR [aOR] = 1.38, 95% CI = 1.14-1.69, p = 0.001). Of the three subgroups of MAFLD (diabetic, nondiabetic overweight/obese, and nondiabetic normal weight/lean with at least two metabolic abnormalities), only diabetic MAFLD was associated with CAC (aOR = 2.65, 95% CI = 1.98-3.55, p < 0.001). When the minimal number of metabolic risk abnormalities increased to three, nondiabetic normal-weight/lean MAFLD was associated with CAC (aOR = 1.35, 95% CI = 1.02-1.77, p = 0.034).
Diabetic MAFLD predicted high-risk CVD phenotypes the best. Metabolic risk abnormalities in nondiabetic MAFLD patients were independently associated with the risk of CVD. The proposed diagnostic criteria for nondiabetic MAFLD need further investigation in terms of CVD risk.
非酒精性脂肪性肝病（NAFLD）的术语最近已被专家小组更改为代谢相关脂肪性肝病（MAFLD），这是基于代谢紊乱提出的。然而，MAFLD 与心血管疾病（CVD）风险相关的临床证据有限。本研究旨在评估这两种术语以及 MAFLD 亚组的心血管风险之间的关联。
在一个单一的医疗检查中心，共纳入了 2133 名同时接受超声和心脏计算机断层扫描检查的个体。超声用于定义脂肪肝，冠状动脉钙化（CAC）定义为 CAC 评分大于 0 用于估计心血管风险。
总体而言，911 名参与者被诊断为脂肪肝。在未调整的分析中，NAFLD（OR=1.4，95%置信区间[CI]=1.05-1.85，p=0.019）和 MAFLD（OR=1.55，95%CI=1.29-1.86，p=0.046）与 CAC 显著相关。然而，在性别和年龄调整分析中，只有 MAFLD 与 CAC 相关（调整后的 OR[aOR]=1.38，95%CI=1.14-1.69，p=0.001）。在 MAFLD 的三个亚组（糖尿病、非糖尿病超重/肥胖和非糖尿病正常体重/瘦且至少有两种代谢异常）中，只有糖尿病 MAFLD 与 CAC 相关（aOR=2.65，95%CI=1.98-3.55，p<0.001）。当代谢风险异常的最小数量增加到三个时，非糖尿病正常体重/瘦 MAFLD 与 CAC 相关（aOR=1.35，95%CI=1.02-1.77，p=0.034）。
糖尿病 MAFLD 预测高危 CVD 表型最佳。非糖尿病 MAFLD 患者的代谢风险异常与 CVD 风险独立相关。需要进一步研究用于 CVD 风险的非糖尿病 MAFLD 的拟议诊断标准。
