Comparison between metabolic-associated fatty liver disease and nonalcoholic fatty liver disease: From nomenclature to clinical outcomes

Table 1 Studies evaluating the risk of cardiovascular disease in patients with nonalcoholic fatty liver disease and metabolic-associated fatty liver disease

Study	Number of patients	Type of study	Outcome measure	Results
Liang et al[168]	6873	Cohort Study with a 4.6 yr follow up	Associations of MAFLD and NAFLD with DM, CKD, and CVD	MAFLD was associated with higher risks of CVD (hazard ratio 1.44; 95%CI, 1.15-1.81); Similar associations were observed for NAFLD, except for a higher incidence of DM in MAFLD patients with HBV infection and excess alcohol consumption
Wang et al[169]	12183	Cross-sectional study (SPECT – China)	Compare the cardiovascular and renal burden between MAFLD and NAFLD patients	The odds ratio of previous CVD was higher in patients with MAFLD. Male 1.50 (1.22,1.85) vs 1.35 (1.1, 1.66); female 1.58 (1.33,1.87) vs 1.45 (1.22, 1.72)
Zhang et al[170]	19617	Nationwide database study	The burden of CKD and CVD in adults with MAFLD and NAFLD	The cardiorenal burden may be greater for MAFLD than for NAFLD
Lee et al[171]	8962813	Cohort study with a 10.1 yr follow up	Association of MAFLD and NAFLD with CVD	MAFLD patients have a higher risk of CKD when compared to NAFLD [1.43 (1.41–1.45) vs 1.09 (1.03–1.15)]
Yoneda et al[172]	2452949	Nationwide database study	Association of MAFLD and NAFLD with CVD	The incidence rates of CVD were 2.82 (95%CI 2.64-3.01) per 1000 person-yr in the NAFLD groups and 2.69 (95%CI 2.55-2.83) per 1000 person-years in the MAFLD groups
Guerreiro et al[173]	1233	Retrospective cross-sectional study	Compare CVR and risk of CVD between patients with NAFLD and MAFLD	In patients with MAFLD and NAFLD, CVR was intermediate/high (36.4 and 25.7%, P = 0.209) and CVD occurred in 20.1 and 12.8% (P = 0.137) of the cases, respectively, with no influence of liver injury severity
Zhang et al[158]	11673	Retrospective study	Compare the risk of CVD between patients with NAFLD and MAFLD	MAFLD was more significant than NAFLD in medium/high 10-yr CVD risk (according to Framingham risk score) [1064 (29.92%) vs 1022 (26.37%), P < 0.005]
Wen et al[147]	-	Meta-analysis	Investigate the risk of CVD incidence or CVD-related mortality in patients diagnosed with MAFLD and NAFLD	The incidence of CVD or CVD mortality was 1.95 times higher in the MAFLD group than in the control group. The risk of CVD or death from CVD was significantly higher in the MAFLD-only group than in the NAFLD-only group, with an RR of 2.57 (95%CI 1.41–4.71; I2 = 78%, P = 0.002)
Guo et al[174]	12794	Cohort study	Study the relationship between MAFLD and incident CVD	The incidence of CVD in the patients with MAFLD was significantly higher than that in the non-MAFLD patients (18.38% vs 9.02%, P ≤ 0.001; aHR = 1.37, 95%CI = 1.20-1.56)
Moon et al[175]	8919	Cohort study	Effect of MAFLD on future mortality and CVD using a prospective community-based cohort study	T2DM in MAFLD increased the risk of both mortality (HR, 2.07; 95%CI, 1.52 to 2.81) and CVD (HR, 1.42; 95%CI, 1.09 to 1.85)
Zou et al[176]	513	Cross-sectional study	Prevalence of MAFLD and its relationship with CVD risks in RA patients	RA patients with MAFLD had a higher rate of CVD events (17.3% vs 9.2%) and a higher proportion of high estimated 10-yr CVD risk (55.5% vs 26.1%) than those without

MAFLD: Metabolic dysfunction associated fatty liver disease; NAFLD: Non-alcoholic fatty liver disease; FL: Fatty liver; FLD: Fatty liver disease; CVD: Cardiovascular disease; CVR: Cardiovascular risk; CKD: Chronic kidney disease; T2DM: Type 2 Diabetes Mellitus; RA: Rheumatoid Arthritis; HR: Hazard ratio; RR: Relative risk; aHR: Adjusted hazard ratio; CI: Confidence Interval; OR: Odds ratio.

Table 2 Studies evaluating the risk of chronic kidney disease in patients with non-alcoholic fatty liver disease and Metabolic dysfunction associated fatty liver disease

Study	Number of patients	Type of Study	Outcome measure	Results
Sun et al[177]	12571	Cross-sectional study	Association between MAFLD and NALFD with CKD	MAFLD patients had lower GFR (74.96 ± 18.21) and higher prevalence of CKD (29.6%)
Liang et al[168]	6873	Cohort Study with a 4.6 yr follow up	Associations of MAFLD and NAFLD with T2DM, CKD, and CVD	MAFLD was associated with a higher risk of CKD (RR 1.64; 95%CI, 1.39-1.94). Similar associations were observed for NAFLD, except for a higher incidence of DM in MAFLD patients with HBV infection and excess alcohol consumption.
Deng et al[178]	4869	A cross-sectional study from the NHANES database 2017 – 2018	Association between MAFLD and CKD	Higher prevalence of CKD in MAFLD subjects than in non-MALFD subjects (22.2% vs 19.1%, P = 0.048)
Wang et al[169]	12183	Cross-sectional study (SPECT – China)	Compare the cardiovascular and renal burden between MAFLD and NAFLD patients	OR of CKD was higher in males with NAFLD [CKD: 1.44 (1.05, 1.96) vs 1.56 (1.14, 2.12)] than those with MAFLD
Su et al[179]	5594	Cross-sectional study	Association between MAFLD and CKD	MAFLD was independently associated with an increased risk of CKD [odds ratio (OR): 1.35, 95%CI: 1.09-1.67]. MAFLD with T2DM had significant associations with increased risk of CKD (OR: 2.85, 95%CI: 2.24-3.63), as well as increased eGFR and UACR
Hu et al[180]	15010	Cross-sectional study	Association between MAFLD and CKD	MAFLD was significantly associated with a higher CKD prevalence (OR 1.715, 95%CI 1.389-2.117, P < 0.001). MAFLD alone was not an independent risk factor for CKD
Hashimoto et al[181]	27371	Cross-sectional study	Association between FLD and MAFLD with CKD	MAFLD was associated with the risk of incident CKD [adjusted hazard ratio 1.24 (1.14-1.36), P < 0.001], whereas FLD without MD was not [1.11 (0.85-1.41), P = 0.433]
Zhang et al[170]	19617	A retrospective nationwide cohort study	Renal burdens in adults with MAFLD and NAFLD	The cardiorenal burden may be greater for MAFLD than for NAFLD
Jung et al[161]	268946	A retrospective nationwide cohort study	Association between MAFLD and NALFD with CKD	The adjusted hazard ratio (aHR) for incident CKD in MAFLD was 1.18 (95%CI, 1.01-1.39; P = 0.040) compared to those with NAFLD
Tanaka et al[182]	13159	Retrospective single-center study	Associations of FL, NAFLD, and MAFLD with the development of CKD	MAFLD [HR (95%CI): 1.12 (1.02-1.26), P = 0.027], but not FL or NAFLD, was an independent risk factor for incident CKD

MAFLD: Metabolic dysfunction associated fatty liver disease; NAFLD: Non-alcoholic fatty liver disease; FL: Fatty liver; FLD: Fatty liver disease; CVD: Cardiovascular disease; CVR: Cardiovascular risk; CKD: Chronic kidney disease; T2DM: Type 2 diabetes mellitus; HR: Hazard ratio; RR: Relative risk; aHR: Adjusted hazard ratio; CI: Confidence Interval; OR: Odds ratio.