Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2023; 15(8): 985-1000
Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.985
Impact renaming non-alcoholic fatty liver disease to metabolic associated fatty liver disease in prevalence, characteristics and risk factors
Xin-Juan Huang, Man Yin, Bing-Qian Zhou, Xin-Yun Tan, Yuan-Qin Xia, Chun-Xiang Qin
Xin-Juan Huang, Man Yin, Bing-Qian Zhou, Xin-Yun Tan, Xiangya Nursing of School, Central South University, Changsha 410013, Hunan Province, China
Yuan-Qin Xia, School of Medicine, Jishou University, Jishou 416000, Hunan Province, China
Chun-Xiang Qin, Department of Health Examination Center, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: All authors on this manuscript made significant contributions to the study; Xinjuan Huang and Chunxiang Qin were primarily involved in the study design; Huang XJ, Zhou BQ, and Yin M were responsible for the analysis and interpretation of data, as well as drafting the manuscript; Tan XY and Xia YQ were involved in the acquisition of data; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 72074225; and Hunan Provincial Key R&D Program, China, No. 2021SK2024.
Institutional review board statement: This study was reviewed and approved by the Central South University Ethics Review Board (IRB2022-S217).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at chunxiangqin@csu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Xiang Qin, MD, PhD, Chief Nurse, Professor, Research Scientist, Department of Health Examination Center, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China. chunxiangqin@csu.edu.cn
Received: May 6, 2023
Peer-review started: May 6, 2023
First decision: June 1, 2023
Revised: June 18, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 27, 2023
Processing time: 107 Days and 17.2 Hours
Abstract
BACKGROUND

Recently, a group of hepatologists proposed to rename non-alcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) with modified diagnostic criteria. It is important to note, however, that there are some differences between the diagnostic criteria used for NAFLD and MAFLD. Since the research on MAFLD is just beginning, however, evidence on its incidence and prevalence in the general population and in specific subpopulations remains limited.

AIM

To assess epidemiology of fatty liver in new definition and compare MAFLD with NAFLD. Exploring risk factors of MAFLD individuals.

METHODS

This was a retrospective, cross-sectional study. A total of 85242 adults were selected from the Chinese health management database in 2017–2022. The data of general information, laboratory indicators, lifestyle management and psychological status were obtained. MAFLD was diagnosed as ultrasound diagnosis of fatty liver and at least one between these three conditions: Overweight/obesity, type 2 diabetes mellitus (T2DM) or metabolic dysregulation. Metabolic factors were not considered in NAFLD diagnosis standard. The clinical characteristics of MAFLD and NAFLD were analysed using descriptive statistics. Continuous variables normally distributed were expressed as means ± SD. Categorical variables were expressed as frequencies and proportions. Binary logistic regression was used to determine risk factors of the MAFLD.

RESULTS

The prevalence of MAFLD and NAFLD was 40.5% and 31.0%, respectively. The MAFLD or NAFLD population is more likely to be older (M: 47.19 ± 10.82 vs 43.43 ± 11.96; N: 47.72 ± 11.17 vs 43.71 ± 11.66), male (M: 77.21% vs 44.43%; N: 67.90% vs 53.12%) and high body mass index (M: 26.79 ± 2.69 vs 22.44 ± 2.48; N: 26.29 ± 2.84 vs 23.29 ± 3.12) than the non-MAFLD or non-MAFLD population. In multivariate analysis, general information (e.g., ≥ 2 metabolic abnormalities OR = 3.38, (95%CI: 2.99-3.81), P < 0.001; diastolic blood pressure OR = 1.01, (95%CI: 1.00–1.01), P = 0.002), laboratory results [e.g.,total bilirubin (TBIL) OR = 0.98, (95%CI: 0.98-0.99), P < 0.001; serum uric acid(SUA) OR = 1.01, (95%CI: 1.01-1.01), P < 0.001], and lifestyle factors [e.g., drink beverage OR = 0.32, (95%CI: 0.17-0.63), P = 0.001] were influence factors for MAFLD. Our study results offer new insight into potential risk factors associated with fatty liver disease, including SUA, TBIL and creatinine, all of which are related to chronic renal disease (CKD).

CONCLUSION

MAFLD is more prevalent than NAFLD, with two-fifths of individuals meeting the diagnosis criteria. MAFLD and NAFLD populations have different clinical characteristics. CKD may be related with MAFLD.

Keywords: Metabolic (dysfunction)-associated fatty liver disease; Non-alcoholic fatty liver disease; Epidemiology; Risk factors; Characteristics; Cross-section study

Core Tip: This study explores the epidemiological characteristics, risk factors and draws reliable conclusions based on the new diagnostic criteria for metabolic associated fatty liver disease, using a large sample of data, and provides evidence for subsequent studies.