Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2024; 16(1): 54-64
Published online Jan 27, 2024. doi: 10.4254/wjh.v16.i1.54
Metabolic puzzle: Exploring liver fibrosis differences in Asian metabolic-associated fatty liver disease subtypes
Sabhita Shabir Shaikh, Fakhar Ali Qazi-Arisar, Saba Nafay, Sidra Zaheer, Hafeezullah Shaikh, Zahid Azam
Sabhita Shabir Shaikh, Fakhar Ali Qazi-Arisar, Saba Nafay, Hafeezullah Shaikh, Zahid Azam, National Institute of Liver and GI Diseases, Dow University of Health Sciences, Sindh, Karachi 75330, Pakistan
Sidra Zaheer, School of Public Health, Dow University of Health Sciences, Sindh, Karachi 75330, Pakistan
Author contributions: Shaikh SS designed the research study; Shaikh SS and Nafay S participated in the data acquisition; Shaikh SS and Zaheer S participated in the analysis and interpretation of the data; Shaikh SS and Qazi-Arisar FA drafted the initial manuscript; Qazi-Arisar FA, Shaikh H, and Azam Z revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Dow University of Health Sciences Institutional Review Board (IRB-1842).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
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: Fakhar Ali Qazi-Arisar, FACP, FCPS, FRCP, MBBS, MRCP, Assistant Professor, National Institute of Liver and GI Diseases, Dow University of Health Sciences, Suparco Road, Gulzar-e-Hijri, Scheme 33, Sindh, Karachi 75330, Pakistan. fakhar.arisar@gmail.com
Received: October 2, 2023
Peer-review started: October 2, 2023
First decision: October 9, 2023
Revised: October 22, 2023
Accepted: December 18, 2023
Article in press: December 18, 2023
Published online: January 27, 2024
Abstract
BACKGROUND

Metabolic-associated fatty liver disease (MAFLD) is a liver condition marked by excessive fat buildup in the absence of heavy alcohol use. It is primarily linked with metabolic issues like insulin resistance, obesity, and abnormal lipid levels, and is often observed with other conditions such as type 2 diabetes and cardiovascular disease. However, whether the subtypes of MAFLD based on the metabolic disorder differentially impact liver fibrosis is not well explicated, especially in the Asian population.

AIM

To compare the severity of liver fibrosis among different MAFLD subtypes.

METHODS

A total of 322 adult patients of either gender with fatty liver on ultrasound were enrolled between January to December 2021. MAFLD was defined as per the Asian Pacific Association for the Study of the Liver guidelines. Fibrosis-4 index (Fib-4) and nonalcoholic fatty liver disease fibrosis score (NFS) were employed to evaluate liver fibrosis.

RESULTS

The mean age was 44.84 ± 11 years. Seventy-two percent of the patients were female. Two hundred and seventy-three patients were classified as having MAFLD, of which 110 (40.3%) carried a single, 129 (47.3%) had two, and 34 (12.5%) had all three metabolic conditions. The cumulative number of metabolic conditions was related to elevated body mass index, triglyceride (TG) levels, and glycated hemoglobin, lower high-density lipoprotein (HDL) levels, higher liver inflammation (by aspartate aminotransferase and γ-glutamyl transferase), and higher likelihood of fibrosis (by NFS and Fib-4 scores) (P < 0.05 for all). The proportion of advanced fibrosis also increased with an increase in the number of metabolic conditions (4.1%, 25.5%, 35.6%, and 44.1% by NFS and 6.1%, 10.9%, 17%, and 26.5% by Fib-4 for no MAFLD and MAFLD with 1, 2, and 3 conditions, respectively). Among MAFLD patients, those with diabetes alone were the eldest and had the highest mean value of NFS score and Fib-4 score (P < 0.05), while MAFLD patients diagnosed with lean metabolic dysfunction exhibited the highest levels of TG and alanine aminotransferase but the lowest HDL levels (P < 0.05).

CONCLUSION

The study suggests that the severity of liver fibrosis in MAFLD patients is influenced by the number and type of metabolic conditions present. Early identification and management of MAFLD, particularly in patients with multiple metabolic conditions, are crucial to prevent liver-related complications.

Keywords: Metabolic syndrome, Diabetes, Fatty liver disease, Dyslipidemia, Obesity

Core Tip: This is the first study on the South-Asian population on assessment of fibrosis among metabolic-associated fatty liver disease (MAFLD) patients. The study highlights that as the number of risk factors increases in a patient with MAFLD, it is more likely to have progression of liver fibrosis.