Metabolically associated fatty liver disease: What hepatologists need to know about this systemic disease

Table 2 Comorbidities associated with metabolically associated fatty liver disease

Condition	Mechanisms/links with MAFLD	Clinical outcomes	Ref.
Type 2 diabetes mellitus	Insulin resistance, chronic hyperglycemia, lipotoxicity	Faster progression to NASH and fibrosis; higher risk of CVD	Byrne et al[263]
Chronic hepatitis B/C	Additive hepatocellular injury, inflammation, altered lipid metabolism	Increased fibrosis progression, higher risk of HCC	Choi et al[175]
Arterial hypertension	Systemic inflammation, endothelial dysfunction, insulin resistance	Greater cardiovascular morbidity, worse liver outcomes	Lonardo et al[235]
Obstructive sleep apnea	Intermittent hypoxia, oxidative stress, systemic inflammation	Worsening fibrosis; increased CVD and metabolic complications	Zhang et al[220]

NASH: Non-alcoholic steatohepatitis; CVD: Cardiovascular disease; HCC: Hepatocellular carcinoma; MAFLD: Metabolically associated fatty liver disease.