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A simpler definition of MAFLD precisely predicts incident metabolic diseases: a 7-year cohort study

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Abstract

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a novel definition proposed in 2020 with a relatively complex set of criteria. Thus, simplified criteria that are more applicable are required. This study aimed to develop a simplified set of criteria for identifying MAFLD and predicting MAFLD-related metabolic diseases.

Methods

We developed a simplified set of metabolic syndrome-based criteria for MAFLD, and compared the performance of the simplified criteria with that of the original criteria in predicting MAFLD-related metabolic diseases in a 7-year follow-up.

Results

In the 7-year cohort, a total of 13,786 participants, including 3372 (24.5%) with fatty liver, were enrolled at baseline. Of the 3372 participants with fatty liver, 3199 (94.7%) met the MAFLD-original criteria, 2733 (81.0%) met the simplified criteria, and 164 (4.9%) were metabolic healthy and met neither of the criteria. During 13,612 person-years of follow-up, 431 (16.0%) fatty liver individuals newly developed T2DM, with an incidence rate of 31.7 per 1000 person-years. Participants who met the simplified criteria had a higher risk of incident T2DM than those who met the original criteria. Similar results were observed for incident hypertension, and incident carotid atherosclerotic plaque.

Conclusion

The MAFLD-simplified criteria are an optimized risk stratification tool for predicting metabolic diseases in fatty liver individuals.

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Data availability

The data that support the findings of this study are available from the corresponding author, Dr. Chengfu Xu, upon reasonable request.

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CIMT:

Carotid Intima-media thickness

C-index:

Concordance index

FPG:

Fasting plasma glucose

HbA1c:

Hemoglobin A1c

HDL-C:

High-density lipoprotein cholesterol

HOMA-IR:

Homeostasis model assessment of insulin resistance

HR:

Hazard ratio

hs-CRP:

High-sensitivity C-reactive protein

IQR:

Interquartile range

LR:

Likelihood ratio

MAFLD:

Metabolic dysfunction-associated fatty liver disease

MetS:

Metabolic syndrome

MHFLD:

Metabolic healthy fatty liver disease

NAFLD:

Nonalcoholic fatty liver disease

NPV:

Negative predictive value

NRI:

Net reclassification improvement

PPV:

Positive predictive value

SD:

Standard deviation

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Acknowledgements

The authors thank all the staff and participants of this study for their important contributions.

Funding

This work was supported by National Key Research and Development Program (2018YFA0109800), National Natural Science Foundation of China (82270602, 82070585, 81770573, 81722009), Key Research and Development Program of Zhejiang Province (2020C03033), and the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2021KY147, 2023KY257).

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Author notes

  1. Jiarong Xie, Lei Xu and Hangkai Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China

    Jiarong Xie, Lei Xu, Hangkai Huang, Yishu Chen, Jinghua Wang, Youming Li, Chaohui Yu & Chengfu Xu

  2. Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo, China

    Jiarong Xie & Lei Xu

  3. Department of Gastroenterology, Ningbo First Hospital, Ningbo, China

    Jiarong Xie & Lei Xu

Authors
  1. Jiarong Xie
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  2. Lei Xu
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  3. Hangkai Huang
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  4. Yishu Chen
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  5. Jinghua Wang
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  6. Youming Li
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  7. Chaohui Yu
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  8. Chengfu Xu
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Contributions

Study concept and design: CX, LX, YL, and CY. Acquisition of data: JX, HH, and YC. Analysis and interpretation of data: JX, LX, HH, JW, and CX. Drafting of the manuscript: JX, LX, and CX. Critical revision of the manuscript for important intellectual content: CX. Obtained funding: CX, JX, and JW. Study supervision: LX, and CX. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Chengfu Xu.

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The authors declares that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committees of Ningbo Hospital of Zhejiang University.

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Xie, J., Xu, L., Huang, H. et al. A simpler definition of MAFLD precisely predicts incident metabolic diseases: a 7-year cohort study. Hepatol Int 17, 1182–1191 (2023). https://doi.org/10.1007/s12072-023-10558-1

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  • DOI: https://doi.org/10.1007/s12072-023-10558-1

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