Diabetes Metab J.  2023 Mar;47(2):220-231. 10.4093/dmj.2021.0327.

Metabolic Dysfunction-Associated Fatty Liver Disease and Mortality: A Population-Based Cohort Study

• Kim KS
• Hong S
• Ahn HY
• Park CY

• KMID: 2540519
• DOI: http://doi.org/10.4093/dmj.2021.0327

Abstract

Background
We investigated whether metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with an elevated risk of all-cause and cardiovascular mortality using a large-scale health examination cohort.
Methods
A total of 394,835 subjects in the Kangbuk Samsung Health Study cohort were enrolled from 2002 to 2012. Participants were categorized by the presence of nonalcoholic fatty liver disease (NAFLD) and MAFLD as follows: normal subjects; patients with both NAFLD and MAFLD; patients with NAFLD only; and patients with MAFLD only. Cox proportional hazards models were used to analyze the risk of mortality.
Results
During a median 5.7 years of follow-up, 20.69% was patients with both NAFLD and MAFLD, 1.51% was patients with NAFLD only, and 4.29% was patients with MAFLD only. All-cause and cardiovascular death was higher in patients with MAFLD than those without MAFLD (P<0.001, respectively). In patients with MAFLD only, the hazard ratio (HR) of all-cause and cardiovascular death was 1.35 (95% confidence interval [CI], 1.13 to 1.60) and 1.90 (95% CI, 1.26 to 2.88) after adjusting for age, which lost its statistical significance by multivariable adjustments. Compared to patients with less than two components of metabolic dysfunction, patients with more than two components of metabolic dysfunction were a higher risk of cardiovascular death (HR, 2.05; 95% CI, 1.25 to 3.38) and only women with more than two components of metabolic dysfunction were a higher risk of all-cause death (HR, 1.44; 95% CI, 1.02 to 2.03).
Conclusion
MAFLD criteria could identify a high-risk group for all-cause and cardiovascular death.

Keyword

Fatty liver; Metabolic syndrome; Mortality; Non-alcoholic fatty liver disease

Figure

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  Fig. 1. All-cause (A, B, C) and cardiovascular (D, E, F) survival rates according to the presence of nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated fatty liver disease (MAFLD). (A) All-cause survival: No NAFLD vs. NAFLD (P=0.200); (B) All-cause survival: No MAFLD vs. MAFLD (P<0.001); (C) All-cause survival: normal vs. NAFLD only vs. MAFLD only vs. both NAFLD and MAFLD (P<0.001); (D) Cardiovascular survival: No NAFLD vs. NAFLD (P=0.002); (E) Cardiovascular survival: No MAFLD vs. MAFLD (P<0.001); (F) Cardiovascular survival: normal vs. NAFLD only vs. MAFLD only vs. both NAFLD and MAFLD (P<0.001).

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  Fig. 2. Risks of all-cause and cardiovascular death according to the presence of (A, B) nonalcoholic fatty liver disease (NAFLD) or (C, D) metabolic dysfunction-associated fatty liver disease (MAFLD). (A) Hazard ratio (HR) of all-cause death in NAFLD patients; (B) HR of cardiovascular death in NAFLD patients; (C) HR of all-cause death in MAFLD patients; (D) HR of cardiovascular death in MAFLD patients. CI, confidence interval.

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