Ruiz-Manriquez Jesus, Olivas-Martinez Antonio, Chávez-García Luis Carlos, Fernández-Ramírez Alfonso, Moctezuma-Velazquez Carlos, Kauffman-Ortega Eric, Castro-Narro Graciela, Astudillo-García Francisco, Escalona-Nandez Ivonne, Aguilar-Salinas Carlos A, Navarro-Alvarez Nalu, Torre Aldo
Hepatology and Liver Transplantation Unit, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México.
Department of Biostatistics, University of Washington, Seattle, Washington.
Gastro Hep Adv. 2022 Mar 30;1(3):352-358. doi: 10.1016/j.gastha.2021.12.011. eCollection 2022.
Metabolic-associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease. Nowadays, the prevalence of MAFLD in Mexico is unknown with no screening point-of-care tools. We aimed to estimate the prevalence of MAFLD in Mexico and to develop a score for MAFLD screening.
We conducted a cross-sectional study in 5 Mexican states, including adult subjects evaluated in checkup campaigns. Subjects underwent a liver ultrasound to look for hepatic steatosis. Based on the most clinically relevant variables associated with MAFLD, we developed the MAFLD-screening score (MAFLD-S). Discrimination and calibration of the score were evaluated using the area under the ROC curve and observed vs predicted plots, respectively.
We included 3357 participants (60% female, mean age 47 ± 12 years). Fifty-two percent had hepatic steatosis, and 47% met MAFLD criteria. Subjects with MAFLD were older (48 ± 11 vs 45 ± 13 years, < .001), were more frequently males (43% vs 36%, < .001), and had a higher body mass index (31.6 + 4.9 vs 25.6 + 3.8 kg/m, < .001) than subjects without MAFLD. The MAFLD-S includes age, body mass index, gender, diabetes, hypertension, and dyslipidemia and has an area under the curve of 0.852, 95% CI = 0.828-0.877, with a sensitivity of 78.8% and a specificity of 82.8% for the optimal cutoff. Using data from the National Health and Nutrition Survey 2018-2019, we predicted a MAFLD national prevalence of 49.6%.
Nearly half of the Mexican population has MAFLD, representing a present and future challenge. With external validation, the MAFLD-S could be a valuable and practical screening tool.
代谢相关脂肪性肝病（MAFLD）是慢性肝病的主要病因。目前，墨西哥MAFLD的患病率尚不清楚，且缺乏即时检测筛查工具。我们旨在估算墨西哥MAFLD的患病率，并制定一个MAFLD筛查评分。
我们在墨西哥5个州开展了一项横断面研究，纳入在体检活动中接受评估的成年受试者。受试者接受肝脏超声检查以寻找肝脂肪变性。基于与MAFLD最相关的临床变量，我们制定了MAFLD筛查评分（MAFLD-S）。分别使用ROC曲线下面积和观察值与预测值曲线评估该评分的辨别力和校准度。
我们纳入了3357名参与者（60%为女性，平均年龄47±12岁）。52%的人有肝脂肪变性，47%符合MAFLD标准。与无MAFLD的受试者相比，MAFLD患者年龄更大（48±11岁对45±13岁，P<.001），男性更常见（43%对36%，P<.001），体重指数更高（31.6 + 4.9对25.6 + 3.8 kg/m²，P<.001）。MAFLD-S包括年龄、体重指数、性别、糖尿病、高血压和血脂异常，曲线下面积为0.852，95%CI = 0.828 - 0.877，最佳截断值时的敏感性为78.8%，特异性为82.8%。利用2018 - 2019年全国健康与营养调查的数据，我们预测MAFLD的全国患病率为49.6%。
近一半的墨西哥人口患有MAFLD，这是当前和未来面临的挑战。经过外部验证后，MAFLD-S可能是一种有价值且实用的筛查工具。
