Recently, the classification of fatty liver and the definition for non-alcoholic fatty liver disease (NAFLD) have been challenged. Herein, this research aims to evaluate the burden of hepatic fibrosis in the missed and added populations following the proposal of the new definition of metabolic dysfunction-associated fatty liver (MAFLD) in a health check-up cohort.
Characteristics | Total (n = 6775) |
Control (n = 2628) |
Neither NAFLD nor MAFLD (n = 46) |
NAFLD (n = 2483) |
NAFLD Only (n = 148) |
MAFLD Only (n = 686) |
Both NAFLD and MAFLD (n = 2335) |
p ‡ | p § | p ‖ |
---|---|---|---|---|---|---|---|---|---|---|
Age (years) † | 46.8 ± 10.3 | 46.4 ± 10.9 | 46.4 ± 10.4 | 47.4 ± 9.8 | 46.5 ± 10.2 | 46.9 ± 9.5 | 47.5 ± 9.8 | 0.875 | 0.228 | 0.636 |
Male | 5460 (80.6) | 1941 (73.9) | 39 (84.8) | 2229 (89.8) | 116 (78.4) | 622 (90.7) | 2113 (90.5) | 0.222 | 0.487 | <0.001 |
Hypertension | 1895 (28) | 559 (21.3) | 4 (8.7) | 916 (36.9) | 11 (7.4) | 236 (34.4) | 905 (38.8) | <0.001 | 0.230 | <0.001 |
Type 2 diabetes | 545 (8) | 103 (3.9) | 0 (0) | 312 (12.9) | 1 (0.7) | 81 (11.8) | 320 (13.7) | 0.043 | 0.435 | <0.001 |
Alcohol consumption (g/week) † | 94 ± 166 | 53 ± 1 | ||||||||
90 (13.1) | ||||||||||
210 (9) | ||||||||||
0.896 | ||||||||||
0.001 | ||||||||||
0.016 | ||||||||||
Advanced fibrosis | ||||||||||
151 (2.2) | ||||||||||
37 (1.4) | ||||||||||
1 (2.2) | 58 (2.3) | 4 (2.7) | 18 (2.6) | 54 (2.3) | 0.204 | 0.663 | 0.957 |
Cut-Off Values (KPa) |
Total (n = 6775) |
Control (n = 2628) |
NAFLD Group (n = 2483) |
NAFLD-Only Group (n = 148) |
MAFLD-Only Group (n = 686) |
p † | p ‡ | p § | p ‖ | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
≥3.0 | 554 (8.2) | 153 (5.8) | 219 (8.8) | 9 (6.1) | 90 (13.1) | 0.896 | 0.001 | 0.016 | <0.001 | ||||||||
≥3.2 | 340 (5) | 84 (3.2) | 136 (5.5) | 6 (4.1) | 54 (7.9) | 0.556 | 0.019 | 0.103 | <0.001 | ||||||||
≥3.4 | 220 (3.2) | 51 (1.9) | 91 (3.7) | 5 (3.4) | 32 (4.7) | 0.226 | 0.230 | 0.491 | <0.001 | ||||||||
≥3.6 | 151 (2.2) | 37 (1.4) | 58 (2.3) | 4 (2.7) | 18 (2.6) | 0.204 | 0.663 | 0.957 | 0.026 | ||||||||
335 ± 229 | 34 ± 54 | 37 ± 57 | 304 ± 248 | 34 ± 54 | 0.391 | ||||||||||||
≥3.8 | 111 (1.6) | 24 (0.9) | 47 (1.9) | 3 (2) | 13 (1.9) | 0.179 | 0.997 | <0.001 | <0.001 | ||||||||
0.915 | 0.029 | Number of metabolic risks † | 1.4 ± 1.3 | 0.9 ± 1 | 0.3 ± 0.4 | 2.1 ± 1.3 | 0.3 ± 0.5 | 2.2 ± 1.2 | 2 ± 1.2 | <0.001 | 0.654 | <0.001 | |||||
≥4.2 | 72 (1.1) | 17 (0.6) | 29 (1.2) | 2 (1.4) | 10 (1.5) | 0.312 | 0.542 | 0.921 | 0.035 | Metabolic syndrome | |||||||
≥4.6 | 1517 (22.4) | 243 (9.2) | 0 (0) | 946 (38.1) | 0 (0) | 250 (36.5) | 946 (40.5) | <0.001 | 0.427 | <0.001 | |||||||
46 (0.7) | 7 (0.3) | 16 (0.6) | 0 (0) | 8 (1.2) | 0.53 | 0.163 | BMI (kg/m2) † | 24.8 ± 3.2 | 23.4 ± 2.6 | 21.8 ± 0.8 | 26.4 ± 3 | 21.6 ± 1.1 | 26.6 ± 2.8 | 26.7 ± 2.8 | <0.001 | 0.076 | <0.001 |
0.187 | 0.002 | Waist circumference (cm) † | 85.3 ± 9.1 | 81.2 ± 8.1 | 79.3 ± 5.3 | 90 ± 7.6 | 78.9 ± 5.1 | 90.6 ± 7.3 | 90.7 ± 7.2 | 0.001 | 0.085 | <0.001 | |||||
Total fat mass (kg) † | 18.5 ± 5.8 | 16.2 ± 4.8 | 13.6 ± 2.6 | 21 ± 5.7 | 13.6 ± 2.7 | 21.6 ± 5.7 | 21.5 ± 5.5 | <0.001 | 0.020 | <0.001 | |||||||
Lean mass (kg) † | 49.1 ± 8.9 | 46.9 ± 8.6 | 44.9 ± 8.2 | 51.8 ± 8.3 | 45.2 ± 6.5 | 52.4 ± 8 | 52.2 ± 8.2 | 0.022 | 0.082 | <0.001 | |||||||
Lean mass * 100/BW | 68.6 | 70.1 | 70.5 | 67.1 | 72.5 | 67 | 66.8 | <0.001 | 0.563 | <0.001 | |||||||
SBP (mmHg) † | 116 ± 13 | 114 ± 13 | 112. ± 11 | 119 ± 13 | 113 ± 10 | 117 ± 13 | 119 ± 13 | 0.234 | 0.006 | <0.001 | |||||||
DBP (mmHg) † | 74 ± 9 | 73 ± 9 | 71 ± 7 | 76 ± 9 | 72 ± 7 | 75 ± 9 | 77 ± 9 | 0.103 | 0.015 | <0.001 | |||||||
AST (IU/L) † | 30 ± 19 | 26 ± 13 | 27 ± 9 | 34 ± 22 | 29 ± 22 | 34 ± 25 | 34 ± 22 | 0.016 | 0.846 | 0.022 | |||||||
ALT (IU/L) † | 32 ± 33 | 23 ± 21 | 27 ± 16 | 41 ± 35 | 28 ± 26 | 42 ± 46 | 42 ± 36 | 0.006 | 0.463 | <0.001 | |||||||
GGT (U/L) † | 55 ± 84 | 43 ± 54 | 43 ± 45 | 72 ± 112 | 57 ± 142 | 62 ± 63 | 73 ± 110 | 0.007 | 0.023 | 0.559 | |||||||
Triglyceride (mg/dL) † | 142 ± 113 | 112 ± 76 | 102 ± 52 | 181 ± 129 | 105 ± 55 | 180 ± 160 | 186 ± 131 | 0.314 | 0.815 | <0.001 | |||||||
HDL (mg/dL) † | 53 ± 12 | 59 ± 13 | 55 ± 11 | 48 ± 10 | 56 ± 12 | 48 ± 10 | 48 ± 10 | 0.772 | 0.465 | <0.001 | |||||||
Glucose (mg/dL) † | 98 ± 20 | 94 ± 16 | 92 ± 7 | 103 ± 24 | 92 ± 9 | 103 ± 24 | 104 ± 24 | 0.051 | 0.657 | <0.001 | |||||||
Liver stiffness (kPa) † | 2.34 ± 0.56 | 2.26 ± 0.51 | 2.36 ± 0.4 | 2.38 ± 0.54 | 2.26 ± 0.51 | 2.43 ± 0.62 | 2.38 ± 0.54 | 0.99 | 0.014 | 0.002 | |||||||
Significant fibrosis | 554 (8.2) | 153 (5.8) | 2 (4.3) | 219 (8.8) | 9 (6.1) |
In conclusion, 94% of sonographic FL cases were compatible with the newly proposed MAFLD definitions. The fibrosis burden of the NAFLD-only group (missed population) was low and was similar to that of the healthy control group. An additional one-tenth of the population with a higher metabolic and fibrosis burden was also compatible with the MAFLD definition.