Georg Semmler1,2, Sarah Wernly1, Sebastian Bachmayer1, Isabella Leitner1, Bernhard Wernly3, Matthias Egger1, Lena Schwenoha1, Leonora Datz1, Lorenz Balcar1,2, Marie Semmler1, Felix Stickel4, David Niederseer5, Elmar Aigner6, Christian Datz1. 1. Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria. 2. Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. 3. Second Department of Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria. 4. Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. 5. Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 6. First Department of Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
Abstract
CONTEXT: Recently, the novel "metabolic dysfunction-associated fatty liver disease" (MAFLD) definition has been introduced. OBJECTIVE: To assess the relevance of MAFLD for mortality. DESIGN: Single-center cohort-study. SETTING: Colorectal cancer screening program. PATIENTS: 4718 subjects aged 45-80 were grouped according to their BMI and the presence or absence of MAFLD. MAIN OUTCOME MEASURES: Mortality was compared among these groups by performing a systematic read-out of the national health insurance system, fatty liver (FL) was diagnosed using ultrasound. RESULTS: Overall prevalence of FL was 47.9%. 1200 (25.4%) were lean (BMI<25kg/m2) and did not have MAFLD, 73 (1.5%) patients were lean and had non-alcoholic fatty liver disease (NAFLD), but did not fulfill criteria for MAFLD, 221 (4.7%) were lean and fulfilled criteria for MAFLD. Additionally, 1043 (22.1%) and 925 (19.6%) subjects had MAFLD with overweight (BMI 25-30kg/m²) and obesity (BMI≥30kg/m²) while 1041 (22.1%) and 215 (4.6%) had overweight and obesity without FL.During a median follow-up of 7.5 (IQR: 4.0-9.6) years, 278 deaths (5.9%) occurred. Of these, 98 (2.1%) were cancer-related, 65 (1.4%) were cardiovascular, and 17 (0.4%) were liver-related. Overall survival was similar between patient strata (after 5 years: 93.9%-98.2%) with lean MAFLD having the numerically worst survival. Although lean and overweight patients with MAFLD had a numerically worse outcome compared to their non-MAFLD counterparts, this association was driven by age and metabolic comorbidities (predominantly diabetes) rather than the presence of MAFLD. CONCLUSIONS: Presence of MAFLD does not increase mortality in a cohort of individuals aged 45-80 years.
CONTEXT: Recently, the novel "metabolic dysfunction-associated fatty liver disease" (MAFLD) definition has been introduced. OBJECTIVE: To assess the relevance of MAFLD for mortality. DESIGN: Single-center cohort-study. SETTING:Colorectal cancer screening program. PATIENTS: 4718 subjects aged 45-80 were grouped according to their BMI and the presence or absence of MAFLD. MAIN OUTCOME MEASURES: Mortality was compared among these groups by performing a systematic read-out of the national health insurance system, fatty liver (FL) was diagnosed using ultrasound. RESULTS: Overall prevalence of FL was 47.9%. 1200 (25.4%) were lean (BMI<25kg/m2) and did not have MAFLD, 73 (1.5%) patients were lean and had non-alcoholic fatty liver disease (NAFLD), but did not fulfill criteria for MAFLD, 221 (4.7%) were lean and fulfilled criteria for MAFLD. Additionally, 1043 (22.1%) and 925 (19.6%) subjects had MAFLD with overweight (BMI 25-30kg/m²) and obesity (BMI≥30kg/m²) while 1041 (22.1%) and 215 (4.6%) had overweight and obesity without FL.During a median follow-up of 7.5 (IQR: 4.0-9.6) years, 278 deaths (5.9%) occurred. Of these, 98 (2.1%) were cancer-related, 65 (1.4%) were cardiovascular, and 17 (0.4%) were liver-related. Overall survival was similar between patient strata (after 5 years: 93.9%-98.2%) with lean MAFLD having the numerically worst survival. Although lean and overweight patients with MAFLD had a numerically worse outcome compared to their non-MAFLD counterparts, this association was driven by age and metabolic comorbidities (predominantly diabetes) rather than the presence of MAFLD. CONCLUSIONS: Presence of MAFLD does not increase mortality in a cohort of individuals aged 45-80 years.