Abstract
Background and aims
Metabolic dysfunction-associated fatty liver disease (MAFLD) establishes new criteria for diagnosis of fatty liver disease independent of alcohol intake. We aimed to describe the prevalence and compare characteristics and mortality outcomes of persons with nonobese and obese MAFLD.
Methods
Using data from 13,640 participants from the third National Health and Nutrition Examination Survey (NHANES III) 1988–1994, we identified participants with fatty liver on ultrasound who had MAFLD and analyzed them by the presence of obesity.
Results
Overall prevalence of MAFLD was 19%; amongst those, 54% were obese and 46% were nonobese. Nonobese MAFLD was more common in participants older than 65 than in younger participants (56.8% vs. 43.2%, p < 0.0001). Nonobese MAFLD was more common in males (63.2% vs. 48.3%, p < 0.0001). Obese MAFLD was more common in females (51.7% vs. 48.3%, p < 0.0001). After adjusting for several demographic factors and alcohol use, older age [adjusted odds ratio (aOR) 1.02, 95% CI 1.00–1.02, p = 0.003] and being male (aOR: 1.65, 95% CI 1.25–2.17, p = 0.001) were independent risk factors for nonobese MAFLD. Nonobese MAFLD participants had a higher 20-year cumulative incidence for all-cause mortality compared to obese MAFLD participants (33.2% vs. 28.8%, p = 0.0137). However, nonobese MAFLD was not independently associated with mortality after adjusting for relevant confounders, while FIB-4 > 1.3 and cardiovascular disease were the strongest risk factors associated with increased mortality [adjusted hazard ratio (aHR) > 2.7 for both, p < 0.0001 for both].
Conclusions
Nonobese MAFLD constitutes about half of the MAFLD in the United States, especially among males and the elderly. Notably, nonobese MAFLD carries higher mortality than obese MAFLD. Screening and diagnosis of MAFLD should be considered in nonobese populations.
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Abbreviations
- aHR:
-
Adjusted hazard ratio
- aOR:
-
Adjusted odds ratio
- ALT:
-
Alanine transaminase
- AST:
-
Aspartate aminotransferase
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- FIB-4:
-
Fibrosis-4
- GGT:
-
Gamma-glutamyl transferase
- HBA1C:
-
Hemoglobin A1C
- HDL-C:
-
High-density lipoprotein cholesterol
- HOMA-IR:
-
Homeostatic model assessment of insulin resistance
- LDL-C:
-
Low-density lipoprotein cholesterol
- MAFLD:
-
Metabolic dysfunction-associated fatty liver disease
- MetS:
-
Metabolic syndrome
- NAFLD:
-
Nonalcoholic fatty liver disease
- NHANES:
-
National Health and Nutrition Examination Survey
- T2DM:
-
Type 2 diabetes mellitus
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Guarantor of the article: MHN. Specific author contributions: Study design: ADD, VHN, MHN. Data collection: ADD, VHN. Data analysis: ADD, VHN, MHN. Drafting of the article: ADD, VHN, MHN. Data interpretation, review and/or revision of the manuscript: All authors. Study concept and study supervision: MHN.
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Mindie H. Nguyen: Research support: Pfizer, Enanta, Gilead, Exact Sciences, Vir Biotech, Helio Health, National Cancer Institute, Glycotest, B. K. Kee Foundation; Consulting and/or Advisory Board: Intercept, Exact Science, Gilead, GSK, Eli Lilly, Laboratory of Advanced Medicine, Janssen. Ramsey Cheung: Research support: Gilead. Allen D. Dao, Vy H. Nguyen and Takanori Ito have no relevant financial or non-financial interests to disclose.
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Dao, A.D., Nguyen, V.H., Ito, T. et al. Prevalence, characteristics, and mortality outcomes of obese and nonobese MAFLD in the United States. Hepatol Int 17, 225–236 (2023). https://doi.org/10.1007/s12072-022-10436-2
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DOI: https://doi.org/10.1007/s12072-022-10436-2