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. 2022 Jan 1;107(1):88-97.
doi: 10.1210/clinem/dgab641.

Association of MAFLD With Diabetes, Chronic Kidney Disease, and Cardiovascular Disease: A 4.6-Year Cohort Study in China

Yebei Liang  1 , Hongli Chen  1 , Yuexing Liu  1 , Xuhong Hou  1 , Li Wei  1 , Yuqian Bao  1 , Chunguang Yang  1 , Geng Zong  2   3 , Jiarui Wu  4 , Weiping Jia  1
Affiliations
Free PMC article

Association of MAFLD With Diabetes, Chronic Kidney Disease, and Cardiovascular Disease: A 4.6-Year Cohort Study in China

Yebei Liang et al. J Clin Endocrinol Metab. .
Free PMC article

Abstract

Context: In 2020, the terminology of metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace nonalcoholic fatty liver disease (NAFLD).

Objectives: This work aimed to investigate the prevalence and incidence of MAFLD and evaluate its effects on incident extrahepatic diseases.

Methods: A total of 6873 individuals, with a 4.6-year follow-up, were included in this study. Associations of MAFLD and NAFLD with diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) were examined using logistic regression and Cox proportional hazards models.

Results: The prevalence of NAFLD and MAFLD was 40.3% (95% CI, 39.2%-41.5%) and 46.7% (95% CI, 45.6%-47.9%), respectively. Additionally, 321 (4.7%) and 156 (2.3%) participants had MAFLD with excessive alcohol consumption and hepatitis B virus (HBV) infection. During the follow-up period, the incidence of NAFLD and MAFLD was 22.7% (95% CI, 21.3%-24.0%) and 27.0% (95% CI, 25.5%-28.4%). MAFLD was associated with higher risks of incident diabetes (risk ratio [RR] 2.08; 95% CI, 1.72-2.52), CKD (RR 1.64; 95% CI, 1.39-1.94), and CVD (hazard ratio 1.44; 95% CI, 1.15-1.81). Similar associations for NAFLD were observed. Furthermore, the MAFLD subgroups with excessive alcohol consumption (RR 2.49; 95% CI, 1.64-3.78) and HBV infection (RR 1.98; 95% CI, 1.11-3.52) were associated with higher risks of incident diabetes.

Conclusion: The change from NAFLD to MAFLD did not greatly affect the associations with diabetes, CKD, and CVD. MAFLD further identified those patients of metabolically fatty liver combined with excessive alcohol consumption and HBV infection, who had increased risks of incident diabetes compared with those of non-fatty liver.

Keywords: cardiovascular disease; chronic kidney disease; diabetes; metabolic dysfunction–associated fatty liver disease; nonalcoholic fatty liver disease.

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Figures

Figure 1.
Figure 1.
Flowchart of study population. MAFLD, metabolic dysfunction-associated fatty liver disease.
Figure 2.
Figure 2.
A, Prevalence, and B, incidence, of nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD).
Figure 3.
Figure 3.
Associations of metabolic dysfunction–associated fatty liver disease (MAFLD) and nonalcoholic fatty liver disease (NAFLD) with prevalent diabetes. *Metabolic dysfunction was defined as the presence of at least 1 of 3 criteria: overweight/obesity, diabetes, or metabolic dysregulation. †Model 1 was adjusted for age and sex. ‡Model 2: model 1 plus adjustment for educational background, smoking status, and leisure-time exercise at baseline. HBV, hepatitis B virus; non-FL, non–fatty liver; OR, odds ratio.
Figure 4.
Figure 4.
Associations of metabolic dysfunction–associated fatty liver disease (MAFLD) and nonalcoholic fatty liver disease (NAFLD) with incident diabetes. *Metabolic dysfunction was defined as the presence of at least 1 of 3 criteria: overweight/obesity, diabetes, or metabolic dysregulation. †Model 1 was adjusted for age and sex. ‡Model 2: model 1 plus adjustment for educational background, smoking status, and leisure-time exercise at baseline. HBV, hepatitis B virus; non-FL, non–fatty liver; RR, risk ratio.
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