Metabolic dysfunction-associated fatty liver disease (MAFLD) establishes new criteria for diagnosing fatty liver disease independent of alcohol intake and concomitant viral hepatitis infection. However, the long-term outcomes of patients with MAFLD are sparse. We aimed to describe the characteristics and long-term survival of persons meeting criteria for NAFLD only (non-MAFLD NAFLD), for both NAFLD and MAFLD (NAFLD-MAFLD), and for MAFLD only (non-NAFLD MAFLD).Using data from the third National Health and Nutrition Examination Survey (NHANES III) 1988 - 1994, 2997 participants with fatty liver identified via ultrasound were categorized into three distinct groups: non-MAFLD NAFLD, NAFLD-MAFLD, and non-NAFLD MAFLD.Participants in the NAFLD-MAFLD and non-NAFLD MAFLD groups were older, had more metabolic traits and higher mean liver enzymes. Nearly 8% of participants in the non-NAFLD MAFLD group had advanced fibrosis (FIB-4 >2.67) while only 1.3% and 1.9% in the NAFLD-MAFLD and non-MAFLD NAFLD groups did, respectively (P <0.0001). Non-NAFLD MAFLD participants had the highest cumulative incidence of all-cause mortality (26.2%) followed by those with NAFLD-MAFLD then non-MAFLD NAFLD participants (21.1% and 10.6%, respectively, P <0.0001). Similar findings were observed for cardiovascular disease (CVD)-related and other-cause (non-CVD, non-cancer) mortality. Non-NAFLD MAFLD was independently associated with all-cause mortality compared to non-MAFLD NAFLD (adjusted hazard ratios: 2.4, 95% CI: 1.2 - 4.6, P = 0.01).MAFLD criteria identified a significant group of people with more comorbidities and worse prognosis compared to those with NAFLD only. These criteria should be considered in the general population to identify high-risk groups for early interventions.
Vy H Nguyen, Michael H Le, Ramsey C Cheung, Mindie H Nguyen