Commentary
Nonalcoholic fatty liver disease (NAFLD) is characterised by the presence of hepatic steatosis without significant alcohol consumption or concomitant liver disease. Individuals with obesity, type 2 diabetes, metabolic syndrome, or dyslipidemia are at a high risk of developing NAFLD. As such, this high-risk group is disproportionately affected by NAFLD’s associated hepatic (liver decompensation and hepatocellular carcinoma) and cardiovascular complications. NAFLD particularly increases the risk of developing atherosclerotic cardiovascular disease (ASCVD) events in these patient populations.
Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed as an alternative to NAFLD that may more effectively predict patients’ risk of developing ASCVD. MAFLD is characterised by the presence of hepatic steatosis specifically with the presence of obesity, diabetes mellitus, or two or more manifestations of metabolic dysregulation.
The aim of this retrospective cohort study was to investigate the superiority of MAFLD vs. NAFLD in predicting ASCVD risk. 46.4% and 41.6% of patients involved in this study had MAFLD and NAFLD respectively. None possessed any ASCVD history.
Key learnings:
Compared to the NAFLD only group, subjects with MAFLD had a higher risk of developing coronary artery disease and intermediate to high ASCVD. Patients with NAFLD only and those without MAFLD or NAFLD had comparable risks of developing coronary artery disease and intermediate to high ASCVD.
This study found that both NAFLD and MAFLD are independently associated with increased ASCVD risk. However, this study was the first to show that MAFLD predicts ASCVD risk better than NAFLD in asymptomatic patients.
