Shaikh Sabhita Shabir, Qazi-Arisar Fakhar Ali, Nafay Saba, Zaheer Sidra, Shaikh Hafeezullah, Azam Zahid
National Institute of Liver and GI Diseases, Dow University of Health Sciences, Sindh, Karachi 75330, Pakistan.
School of Public Health, Dow University of Health Sciences, Sindh, Karachi 75330, Pakistan.
World J Hepatol. 2024 Jan 27;16(1):54-64. doi: 10.4254/wjh.v16.i1.54.
Metabolic-associated fatty liver disease (MAFLD) is a liver condition marked by excessive fat buildup in the absence of heavy alcohol use. It is primarily linked with metabolic issues like insulin resistance, obesity, and abnormal lipid levels, and is often observed with other conditions such as type 2 diabetes and cardiovascular disease. However, whether the subtypes of MAFLD based on the metabolic disorder differentially impact liver fibrosis is not well explicated, especially in the Asian population.
To compare the severity of liver fibrosis among different MAFLD subtypes.
A total of 322 adult patients of either gender with fatty liver on ultrasound were enrolled between January to December 2021. MAFLD was defined as per the Asian Pacific Association for the Study of the Liver guidelines. Fibrosis-4 index (Fib-4) and nonalcoholic fatty liver disease fibrosis score (NFS) were employed to evaluate liver fibrosis.
The mean age was 44.84 ± 11 years. Seventy-two percent of the patients were female. Two hundred and seventy-three patients were classified as having MAFLD, of which 110 (40.3%) carried a single, 129 (47.3%) had two, and 34 (12.5%) had all three metabolic conditions. The cumulative number of metabolic conditions was related to elevated body mass index, triglyceride (TG) levels, and glycated hemoglobin, lower high-density lipoprotein (HDL) levels, higher liver inflammation (by aspartate aminotransferase and γ-glutamyl transferase), and higher likelihood of fibrosis (by NFS and Fib-4 scores) ( < 0.05 for all). The proportion of advanced fibrosis also increased with an increase in the number of metabolic conditions (4.1%, 25.5%, 35.6%, and 44.1% by NFS and 6.1%, 10.9%, 17%, and 26.5% by Fib-4 for no MAFLD and MAFLD with 1, 2, and 3 conditions, respectively). Among MAFLD patients, those with diabetes alone were the eldest and had the highest mean value of NFS score and Fib-4 score ( < 0.05), while MAFLD patients diagnosed with lean metabolic dysfunction exhibited the highest levels of TG and alanine aminotransferase but the lowest HDL levels ( < 0.05).
The study suggests that the severity of liver fibrosis in MAFLD patients is influenced by the number and type of metabolic conditions present. Early identification and management of MAFLD, particularly in patients with multiple metabolic conditions, are crucial to prevent liver-related complications.
代谢相关脂肪性肝病（MAFLD）是一种在无大量饮酒情况下以肝脏脂肪过度堆积为特征的肝脏疾病。它主要与胰岛素抵抗、肥胖和血脂异常等代谢问题相关，并且常与2型糖尿病和心血管疾病等其他病症同时出现。然而，基于代谢紊乱的MAFLD亚型是否对肝纤维化有不同影响尚未得到充分阐明，尤其是在亚洲人群中。
比较不同MAFLD亚型之间肝纤维化的严重程度。
2021年1月至12月期间，共纳入322例超声检查发现有脂肪肝的成年患者，无论性别。MAFLD根据亚太肝脏研究协会指南进行定义。采用Fibrosis-4指数（Fib-4）和非酒精性脂肪性肝病纤维化评分（NFS）评估肝纤维化。
平均年龄为44.84±11岁。72%的患者为女性。273例患者被分类为患有MAFLD，其中110例（40.3%）有一种代谢状况，129例（47.3%）有两种代谢状况，34例（12.5%）有三种代谢状况。代谢状况的累积数量与体重指数升高、甘油三酯（TG）水平、糖化血红蛋白升高、高密度脂蛋白（HDL）水平降低、肝脏炎症（通过天冬氨酸转氨酶和γ-谷氨酰转移酶）升高以及纤维化可能性增加（通过NFS和Fib-4评分）相关（所有P<0.05）。随着代谢状况数量的增加，进展期纤维化的比例也增加（无MAFLD以及患有1种、2种和3种代谢状况的MAFLD患者，NFS评分对应的比例分别为4.1%、25.5%、35.6%和44.1%，Fib-4评分对应的比例分别为6.1%、10.9%、17%和26.5%）。在MAFLD患者中，仅患有糖尿病的患者年龄最大，NFS评分和Fib-4评分的平均值最高（P<0.05），而被诊断为瘦素代谢功能障碍的MAFLD患者TG和丙氨酸转氨酶水平最高，但HDL水平最低（P<0.05）。
该研究表明，MAFLD患者肝纤维化的严重程度受存在的代谢状况的数量和类型影响。早期识别和管理MAFLD，尤其是在患有多种代谢状况的患者中，对于预防肝脏相关并发症至关重要。
