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Multicenter Study
. 2023 Jul 15;17(4):610-619.
doi: 10.5009/gnl220400. Epub 2023 Feb 17.

Fibrotic Burden in the Liver Differs Across Metabolic Dysfunction-Associated Fatty Liver Disease Subtypes

Tae Seop Lim  1   2 , Ho Soo Chun  3   4 , Soon Sun Kim  5 , Ja Kyung Kim  1   2 , Minjong Lee  3   4 , Hyo Jung Cho  5 , Seung Up Kim  1   6 , Jae Youn Cheong  5
Affiliations
Multicenter Study

Fibrotic Burden in the Liver Differs Across Metabolic Dysfunction-Associated Fatty Liver Disease Subtypes

Tae Seop Lim et al. Gut Liver. .

Abstract

Background/aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) is categorized into three subtypes: overweight/obese (OW), lean/normal weight with metabolic abnormalities, and diabetes mellitus (DM). We investigated whether fibrotic burden in liver differs across subtypes of MAFLD patients.

Methods: This cross-sectional multicenter study was done in cohorts of subjects who underwent a comprehensive medical health checkup between January 2014 and December 2020. A total of 42,651 patients with ultrasound-diagnosed fatty liver were included. Patients were classified as no MAFLD, OW-MAFLD, lean-MAFLD, and DM-MAFLD. Advanced liver fibrosis was defined based on the nonalcoholic fatty liver disease fibrosis score (NFS) or fibrosis-4 (FIB-4) index.

Results: The mean age of the patients was 50.0 years, and 74.1% were male. The proportion of patients with NFS-defined advanced liver fibrosis was the highest in DM-MAFLD (6.6%), followed by OW-MAFLD (2.0%), lean-MAFLD (1.3%), and no MAFLD (0.2%). The proportion of patients with FIB-4-defined advanced liver fibrosis was the highest in DM-MAFLD (8.6%), followed by lean-MAFLD (3.9%), OW-MAFLD (3.0%), and no MAFLD (2.0%). With the no MAFLD group as reference, the adjusted odds ratios (95% confidence intervals) for NFS-defined advanced liver fibrosis were 4.46 (2.09 to 9.51), 2.81 (1.12 to 6.39), and 9.52 (4.46 to 20.36) in OW-MAFLD, lean-MAFLD, and DM-MAFLD, respectively, and the adjusted odds ratios for FIB-4-defined advanced liver fibrosis were 1.03 (0.78 to 1.36), 1.14 (0.82 to 1.57), and 1.97 (1.48 to 2.62) in OW-MAFLD, lean-MAFLD, and DM-MAFLD.

Conclusions: Fibrotic burden in the liver differs across MAFLD subtypes. Optimized surveillance strategies and therapeutic options might be needed for different MAFLD subtypes.

Keywords: Liver fibrosis; Metabolic dysfunction-associated fatty liver disease; Non-alcoholic fatty liver disease; Subtype.

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Conflict of interest statement

CONFLICTS OF INTEREST

S.U.K. has served as an advisory committee member Gilead Sciences, GSK, Bayer, and Eisai. He is a speaker for Gilead Sciences, GSK, Bayer, Eisai, Abbvie, Echosens, MSD, and Bristol-Myers Squibb. He has also received a research grant from Abbvie, Bristol-Myers Squibb. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart displaying the selection process for the study participants. AST, aspartate aminotransferase; ALT, alanine aminotransferase.
Fig. 2
Fig. 2
Proportion of advanced liver fibrosis defined by NFS (A) and FIB-4 (B), according to the presence and subtypes of MAFLD. OR, odds ratio; CI, confidence interval; NFS, nonalcoholic fatty liver disease (NAFLD) fibrosis score; FIB-4, fibrosis-4 index; MAFLD, metabolic dysfunction-associated fatty liver disease; OW, overweight/obese; DM, diabetes mellitus.
See this image and copyright information in PMC

Comment in

References

    1. Gadiparthi C, Spatz M, Greenberg S, et al. NAFLD epidemiology, emerging pharmacotherapy, liver transplantation implications and the trends in the United States. J Clin Transl Hepatol. 2020;8:215–221. doi: 10.14218/JCTH.2020.00014. - DOI - PMC - PubMed
    1. Kang SH, Lee HW, Yoo JJ, et al. KASL clinical practice guidelines: management of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2021;27:363–401. doi: 10.3350/cmh.2021.0178.5e619f1e8a03491a9049cdb8fcc3ba9f - DOI - PMC - PubMed
    1. Murag S, Ahmed A, Kim D. Recent epidemiology of nonalcoholic fatty liver disease. Gut Liver. 2021;15:206–216. doi: 10.5009/gnl20127. - DOI - PMC - PubMed
    1. Chun HS, Lee M, Lee HA, et al. Association of physical activity with risk of liver fibrosis, sarcopenia, and cardiovascular disease in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2023;21:358–369. doi: 10.1016/j.cgh.2021.12.043. - DOI - PubMed
    1. Kim HY. Recent advances in nonalcoholic fatty liver disease metabolomics. Clin Mol Hepatol. 2021;27:553–559. doi: 10.3350/cmh.2021.0127.d605059b61774815bd0e2918d623c623 - DOI - PMC - PubMed

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