Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2023; 15(8): 985-1000
Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.985
Impact renaming non-alcoholic fatty liver disease to metabolic associated fatty liver disease in prevalence, characteristics and risk factors
Xin-Juan Huang, Man Yin, Bing-Qian Zhou, Xin-Yun Tan, Yuan-Qin Xia, Chun-Xiang Qin
Xin-Juan Huang, Man Yin, Bing-Qian Zhou, Xin-Yun Tan, Xiangya Nursing of School, Central South University, Changsha 410013, Hunan Province, China
Yuan-Qin Xia, School of Medicine, Jishou University, Jishou 416000, Hunan Province, China
Chun-Xiang Qin, Department of Health Examination Center, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: All authors on this manuscript made significant contributions to the study; Xinjuan Huang and Chunxiang Qin were primarily involved in the study design; Huang XJ, Zhou BQ, and Yin M were responsible for the analysis and interpretation of data, as well as drafting the manuscript; Tan XY and Xia YQ were involved in the acquisition of data; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 72074225; and Hunan Provincial Key R&D Program, China, No. 2021SK2024.
Institutional review board statement: This study was reviewed and approved by the Central South University Ethics Review Board (IRB2022-S217).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at chunxiangqin@csu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Xiang Qin, MD, PhD, Chief Nurse, Professor, Research Scientist, Department of Health Examination Center, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan Province, China. chunxiangqin@csu.edu.cn
Received: May 6, 2023
Peer-review started: May 6, 2023
First decision: June 1, 2023
Revised: June 18, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 27, 2023
ARTICLE HIGHLIGHTS
Research background

Metabolic associated fatty liver disease (MAFLD) is renamed from non-alcoholic fatty liver disease (NAFLD), but there are differences in diagnostic criteria. Since the research on MAFLD is just beginning, however, evidence on its incidence and prevalence in the general population and in specific subpopulations remains limited.

Research motivation

MAFLD proposal is not only a change in nomenclature. On one hand, MAFLD includes patients with concomitant liver diseases and secondary causes of fatty liver. On the other hand, patients with hepatic steatosis but not fulfilling the metabolic criteria are not classified as MAFLD. How these criteria affect our understanding of the epidemiology of MAFLD is unclear. The clinical characteristics and risk factors between MAFLD and NAFLD has not been adequately explored. We aimed to further clarify a possible link and difference between the two diagnostic criteria.

Research objectives

We sought to assess the impact of the new definition on the epidemiology of fatty liver disease and compare MAFLD with NAFLD in a general population. Potential risk factors of MAFLD-diagnosed individuals were also explored.

Research methods

A total of 85242 adults were selected from the Chinese health management database in 2017–2022. Specifically, the participants were divided into MAFLD group, NAFLD group and MAFLD & NAFLD group for analysis and comparison. Several elements were included such as prevalence, disease characteristics, and risk factors.

Research results

We found a higher prevalence of MAFLD than NAFLD. There are differences in clinical features between MAFLD, NAFLD and MAFLD & NAFLD. In addition to the common risk factors, we identified CKD may be related with MAFLD.

Research conclusions

MAFLD was more prevalent than NAFLD in the study population, with two-fifths of individuals meeting the diagnosis criteria. Compared to NAFLD, MAFLD has its own disease characteristics and risk factors. Intervention program should address the risk factors for MAFLD and regular screening for the disease is recommended.

Research perspectives

Some of the risk factors for MAFLD have been initially identified, but cross-sectional studies of causality are weak. In the future, multi-centre, multi-regional longitudinal studies could be conducted to elucidate disease characteristics, disease trajectory and risk factors in depth.