Clin Gastroenterol Hepatol. 2022 Sep 21:S1542-3565(22)00912-0. Doi: 10.1016/j.cgh.2022.

09.014 . Online ahead of print.PMID: 36152895

Non-Alcoholic Fatty Liver Disease Without Metabolic Associated Fatty Liver Disease and the Risk of Metabolic Syndrome

Dong Hyun Sinn , Danbee Kang , Sung Chul Choi , Yun Soo Hong , Di Zhao , Eliseo Guallar , Yewan Park , Juhee Cho , Geum-Youn Gwak 

 Abstract

Background & aims: Metabolic (dysfunction) associated fatty liver disease (MAFLD) was proposed to replace non-alcoholic fatty liver (NAFLD). Some people fulfill diagnostic criteria of NAFLD but not MAFLD (NAFLD without MAFLD), but the clinical implications of NAFLD in these subjects is unknown.

Methods: We followed cohort of 12,197 men and women 20 years of age or older without metabolic dysfunction (defined by MAFLD criteria), heavy alcohol use, chronic viral hepatitis, liver cirrhosis or malignancy for their risk of incident metabolic syndrome defined by ATP III criteria.

Results: By design, none of the study participants had MAFLD at baseline. The prevalence of NAFLD among participants without metabolic dysfunction meeting MAFLD criteria and without significant alcohol intake was 7.6%. During 74,508 person-years of follow-up, 2,179 participants developed metabolic syndrome. The fully adjusted hazard ratio for metabolic syndrome comparing participants with NAFLD to those without it was 1.61 (95% confidence interval, 1.42,1.83). The increased risk of incident metabolic syndrome associated with NAFLD persisted for all studied subgroups, and the association was stronger for those with increased waist circumference (p for interaction = 0.029) and those without elevated triglycerides levels (p for interaction = 0.047).

Conclusion: In this large cohort, participants with NAFLD without MAFLD were at higher risk of developing metabolic syndrome compared to participants with no NAFLD and no MAFLD. Using MAFLD criteria may miss opportunities for early intervention in these subjects.