Elsabaawy Maha, Naguib Madiha, Abuamer Ahmed, Shaban Ahmed
Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen Elkoom, Menoufia, Egypt.
Clin Exp Med. 2025 Jan 14;25(1):36. doi: 10.1007/s10238-024-01553-3.
The diagnostic criteria for Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Metabolic Associated Steatotic Liver Disease (MASLD) aim to refine the classification of fatty liver diseases previously grouped under Non-Alcoholic Fatty Liver Disease (NAFLD). This study evaluates the applicability of the MAFLD and MASLD frameworks in NAFLD patients, exploring their clinical utility in identifying high-risk patients. A total of 369 NAFLD patients were assessed using MAFLD and MASLD diagnostic criteria. Baseline characteristics, metabolic profiles, hepatic fibrosis, and cardiovascular risks were compared across the groups. Among NAFLD patients, 97.55% (n = 359) met MASLD criteria, and 97.01% (n = 357) fulfilled MAFLD criteria. Both frameworks MAFLD and MASLD captured overlapping populations, with MASLD encompassing slightly more cases. No significant differences were observed in metabolic risk factors, fibrosis indices (APRI, FIB-4, NAFLD fibrosis score), or cardiovascular risk (10-year ASCVD score). A small subset of lean NAFLD patients (10 cases) with distinct profiles remained uncategorized by either framework. Pure NAFLD cases (n = 10) were with mild insulin resistance (HOMA-IR: 3.07 ± 0.33) and slightly elevated LDL (102.5 ± 42.87 mg/dL), while fibrosis indices indicated low fibrosis risk. Steatosis indices supported the diagnosis of early-stage NAFLD with preserved liver function. These patients do not meet the criteria for inclusion in the MAFLD or MASLD frameworks, highlighting a gap in the current diagnostic systems. MAFLD and MASLD criteria align closely with NAFLD in capturing patients with metabolic risk with MASLD-enhanced inclusivity. Further refinement is required to address heterogeneity, particularly in lean NAFLD patients. Hypertension prevalence was comparable (17.4% in NAFLD, 18.2% in MAFLD, 17.8% in MASLD; p = 0.960), as was diabetes mellitus (36.7%, 37.8%, and 37.6%, respectively; p = 0.945). Body mass index was also similar across groups, with medians of 33.25, 33.6, and 33.4 kg/m (p = 0.731). Non-invasive markers of hepatic fibrosis, including APRI, FIB-4, and NAFLD fibrosis scores, did not differ significantly, with median FIB-4 scores around 1.05 (p = 0.953). Similarly, were the results of hepatic steatosis index and ASCVD score.
代谢功能障碍相关脂肪性肝病（MAFLD）和代谢相关脂肪性肝病（MASLD）的诊断标准旨在完善先前归类于非酒精性脂肪性肝病（NAFLD）的脂肪性肝病分类。本研究评估了MAFLD和MASLD框架在NAFLD患者中的适用性，探讨了它们在识别高危患者方面的临床效用。使用MAFLD和MASLD诊断标准对总共369例NAFLD患者进行了评估。对各组的基线特征、代谢谱、肝纤维化和心血管风险进行了比较。在NAFLD患者中，97.55%（n = 359）符合MASLD标准，97.01%（n = 357）符合MAFLD标准。MAFLD和MASLD这两个框架都涵盖了重叠的人群，其中MASLD涵盖的病例略多。在代谢危险因素、纤维化指标（APRI、FIB-4、NAFLD纤维化评分）或心血管风险（10年ASCVD评分）方面未观察到显著差异。一小部分具有独特特征的瘦NAFLD患者（10例）未被这两个框架归类。单纯NAFLD病例（n = 10）具有轻度胰岛素抵抗（HOMA-IR：3.07±0.33）和低密度脂蛋白轻度升高（102.5±42.87 mg/dL），而纤维化指标表明纤维化风险较低。脂肪变性指标支持肝功能正常的早期NAFLD诊断。这些患者不符合纳入MAFLD或MASLD框架的标准，凸显了当前诊断系统中的一个空白。MAFLD和MASLD标准在捕获具有代谢风险的患者方面与NAFLD密切一致，且MASLD的包容性更强。需要进一步完善以解决异质性问题，特别是在瘦NAFLD患者中。高血压患病率相当（NAFLD中为17.4%，MAFLD中为18.2%，MASLD中为17.8%；p = 0.960），糖尿病患病率也相当（分别为36.7%、37.8%和37.6%；p = 0.945）。各组的体重指数也相似，中位数分别为33.25、33.6和33.4 kg/m²（p = 0.731）。包括APRI、FIB-4和NAFLD纤维化评分在内的肝纤维化非侵入性标志物无显著差异，FIB-4评分中位数约为1.05（p = 0.953）。肝脂肪变性指数和ASCVD评分结果也相似。
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