Tsubasa Tsutsumi1, Mohammed Eslam2, Takumi Kawaguchi1, Sakura Yamamura1, Atsushi Kawaguchi3, Dan Nakano1, Masahiro Koseki4, Shinobu Yoshinaga5, Hirokazu Takahashi6, Keizo Anzai6, Jacob George2, Takuji Torimura1. 1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan. 2. Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia. 3. Center for Comprehensive Community Medicine Faculty of Medicine, Saga University, Saga, Saga, 849-8501, Japan. 4. Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine. 5. Medical Examination Section, Medical Examination Part Facilities, Public Utility Foundation Saga Prefectural Health Promotion Foundation, Saga, Japan. 6. Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.
Abstract
AIM: Metabolic associated fatty liver disease (MAFLD) partly overlaps with non-alcoholic fatty liver disease (NAFLD). Thus, using a generalized estimating equation (GEE) approach, we aimed to investigate the difference in worsening of atherosclerotic cardiovascular disease (ASCVD) risk between patients with MAFLD and NAFLD. We also investigated factors related to the difference between the two groups. METHODS: We enrolled 2,306 subjects with fatty liver (MAFLD 80.7%, NAFLD 63.4%). Subjects with MAFLD/NAFLD were sub-classified into 3 groups: NAFLD with no metabolic dysfunction (non-Met NAFLD), overlapping, and MAFLD with moderate alcohol consumption (mod-Alc MAFLD) groups. ASCVD risk was estimated by non-invasive tests including the Suita score. An event was defined as worsening of these scores from the low-risk to the high-risk group. Independent factors for the event were analyzed by Cox regression analysis with the GEE. RESULTS: In Cox regression analysis, MAFLD (HR 1.08, 95%CI 1.02-1.15, P=0.014) and alcohol consumption (20-39 gms/day; HR 1.73, 95%CI 1.26-2.36, P=0.001) were independently associated with worsening of the Suita score. In a sub-analysis, the incidence of the event was significantly lower in non-Met NAFLD than in the overlapping group (HR 0.70, 95%CI 0.50-0.98, P=0.042). However, no significant difference was observed in the incidence between the overlapping and mod-Alc MAFLD group (HR 1.19, 95%CI 0.89-1.58, P=0.235). CONCLUSIONS: The GEE approach demonstrates that MAFLD better identifies patients with worsening of ASCVD risk than NAFLD. Moreover, the superiority of MAFLD over NAFLD was due to the presence of metabolic dysfunction rather than moderate alcohol consumption. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
AIM: Metabolic associated fatty liver disease (MAFLD) partly overlaps with non-alcoholic fatty liver disease (NAFLD). Thus, using a generalized estimating equation (GEE) approach, we aimed to investigate the difference in worsening of atherosclerotic cardiovascular disease (ASCVD) risk between patients with MAFLD and NAFLD. We also investigated factors related to the difference between the two groups. METHODS: We enrolled 2,306 subjects with fatty liver (MAFLD 80.7%, NAFLD 63.4%). Subjects with MAFLD/NAFLD were sub-classified into 3 groups: NAFLD with no metabolic dysfunction (non-Met NAFLD), overlapping, and MAFLD with moderate alcohol consumption (mod-Alc MAFLD) groups. ASCVD risk was estimated by non-invasive tests including the Suita score. An event was defined as worsening of these scores from the low-risk to the high-risk group. Independent factors for the event were analyzed by Cox regression analysis with the GEE. RESULTS: In Cox regression analysis, MAFLD (HR 1.08, 95%CI 1.02-1.15, P=0.014) and alcohol consumption (20-39 gms/day; HR 1.73, 95%CI 1.26-2.36, P=0.001) were independently associated with worsening of the Suita score. In a sub-analysis, the incidence of the event was significantly lower in non-Met NAFLD than in the overlapping group (HR 0.70, 95%CI 0.50-0.98, P=0.042). However, no significant difference was observed in the incidence between the overlapping and mod-Alc MAFLD group (HR 1.19, 95%CI 0.89-1.58, P=0.235). CONCLUSIONS: The GEE approach demonstrates that MAFLD better identifies patients with worsening of ASCVD risk than NAFLD. Moreover, the superiority of MAFLD over NAFLD was due to the presence of metabolic dysfunction rather than moderate alcohol consumption. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Authors: Mohammed Eslam; Hashem B El-Serag; Sven Francque; Shiv K Sarin; Lai Wei; Elisabetta Bugianesi; Jacob George Journal: Nat Rev Gastroenterol Hepatol Date: 2022-06-16 Impact factor: 73.082
Authors: Yasser Fouad; Melissa Palmer; Minjun Chen; Arie Regev; Rajarshi Banerjee; Rob Myers; Robert Riccio; Richard Torstenson; Ramy Younes; Puneet S Arora; Henrik Landgren; Morten A Karsdal; Martin Blake; David A Shapiro; Hans-Juergen Gruss; Muhammad Y Sheikh; Dina Attia; Steven Bollipo; Alastair D Smith; Bradley Freilich; Robert G Gish; Detlef Schuppan Journal: J Clin Transl Hepatol Date: 2021-10-22