TY - JOUR
T1 - The Spectrum and Impact of Metabolic Dysfunction in MAFLD
T2 - A Longitudinal Cohort Analysis of 32,683 Overweight and Obese Individuals
AU - Chan, Kai En
AU - Ng, Cheng Han
AU - Fu, Clarissa Elysia
AU - Quek, Jingxuan
AU - Kong, Gwyneth
AU - Goh, Yi Jie
AU - Zeng, Rebecca Wenling
AU - Tseng, Michael
AU - Aggarwal, Manik
AU - Nah, Benjamin
AU - Chee, Douglas
AU - Wong, Zhen Yu
AU - Zhang, Sitong
AU - Wang, Jiong Wei
AU - Chew, Nicholas W.S.
AU - Dan, Yock Young
AU - Siddiqui, Mohammad Shadab
AU - Noureddin, Mazen
AU - Sanyal, Arun J.
AU - Muthiah, Mark
N1 - Publisher Copyright:
© 2023 AGA Institute
PY - 2023/9
Y1 - 2023/9
N2 - BACKGROUND: Metabolic associated fatty liver disease (MAFLD) was recently proposed as an alternative name change for better encapsulation of disease. However, there exists a spectrum of MAFLD where both metabolically healthy (MH) and metabolically unhealthy (MU) individuals are included. In view of limited evidence, we sought to examine the prevalence, clinical characteristics, and differences in outcomes of MH-MAFLD at the population level.METHODS: Data were used from the United States National Health and Nutrition Examination Survey 1999 to 2018. Multivariate logistic regression analysis was used to obtain odds ratios for the estimation of events. Survival analysis was conducted with Cox regression and the Fine-Gray subdistribution model.RESULTS: There were 32,683 overweight and obese individuals included in the analysis. In MAFLD patients, the prevalence of MH-MAFLD was 6.92% (95% confidence interval [CI], 6.58%-7.27%), and 93.08% (95% CI, 92.73%-93.42%) were considered as MU-MAFLD. Multivariate analysis found a significantly higher risk of MACE (odds ratio, 1.38; 95% CI, 1.28-1.49; P < .01), all-cause (hazard ratio, 1.24; 95% CI, 1.17-1.32; P < .01), cardiovascular disease (SHR, 1.20; 95% CI, 1.02-1.42; P = .03), and cancer mortality (SHR, 1.24; 95% CI, 1.07-1.44; P < .01) in MU-MAFLD relative to non-MAFLD. However, MH-MAFLD individuals were not associated with a statistically significant increased risk of these adverse outcomes compared with non-MAFLD. MU-MAFLD diabetics were also at a higher risk of adverse events compared with non-diabetics.CONCLUSIONS: This study reports on the heterogeneity and spectrum of metabolic dysfunction that exists in overweight and obese MAFLD. Although MAFLD may potentially be advantageous in improving awareness and patient outcomes, there remains substantial heterogeneity within patients included in MAFLD on the basis of the underlying metabolic burden.
AB - BACKGROUND: Metabolic associated fatty liver disease (MAFLD) was recently proposed as an alternative name change for better encapsulation of disease. However, there exists a spectrum of MAFLD where both metabolically healthy (MH) and metabolically unhealthy (MU) individuals are included. In view of limited evidence, we sought to examine the prevalence, clinical characteristics, and differences in outcomes of MH-MAFLD at the population level.METHODS: Data were used from the United States National Health and Nutrition Examination Survey 1999 to 2018. Multivariate logistic regression analysis was used to obtain odds ratios for the estimation of events. Survival analysis was conducted with Cox regression and the Fine-Gray subdistribution model.RESULTS: There were 32,683 overweight and obese individuals included in the analysis. In MAFLD patients, the prevalence of MH-MAFLD was 6.92% (95% confidence interval [CI], 6.58%-7.27%), and 93.08% (95% CI, 92.73%-93.42%) were considered as MU-MAFLD. Multivariate analysis found a significantly higher risk of MACE (odds ratio, 1.38; 95% CI, 1.28-1.49; P < .01), all-cause (hazard ratio, 1.24; 95% CI, 1.17-1.32; P < .01), cardiovascular disease (SHR, 1.20; 95% CI, 1.02-1.42; P = .03), and cancer mortality (SHR, 1.24; 95% CI, 1.07-1.44; P < .01) in MU-MAFLD relative to non-MAFLD. However, MH-MAFLD individuals were not associated with a statistically significant increased risk of these adverse outcomes compared with non-MAFLD. MU-MAFLD diabetics were also at a higher risk of adverse events compared with non-diabetics.CONCLUSIONS: This study reports on the heterogeneity and spectrum of metabolic dysfunction that exists in overweight and obese MAFLD. Although MAFLD may potentially be advantageous in improving awareness and patient outcomes, there remains substantial heterogeneity within patients included in MAFLD on the basis of the underlying metabolic burden.
KW - Adverse Outcomes
KW - All-Cause Mortality
KW - Metabolic Diseases
KW - Metabolic-associated Fatty Liver Disease
KW - Nonalcoholic Fatty Liver Disease
KW - Overweight/complications
KW - Cardiovascular Diseases
KW - Nutrition Surveys
KW - Humans
KW - Non-alcoholic Fatty Liver Disease
KW - Obesity/complications
KW - Health Status
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U2 - 10.1016/j.cgh.2022.09.028
DO - 10.1016/j.cgh.2022.09.028
M3 - Article
C2 - 36202348
AN - SCOPUS:85150460888
SN - 1542-3565
VL - 21
SP - 2560-2569.e15
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 10
ER -