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Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study

  • Hokyou Lee
    Affiliations
    Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Yong-ho Lee
    Correspondence
    Yong-ho Lee, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. fax: +82-2-393-6884.
    Affiliations
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

    Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
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  • Seung Up Kim
    Correspondence
    Seung Up Kim, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. fax: +82-2-393-6884.
    Affiliations
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

    Yonsei Liver Center, Severance Hospital, Seoul, Korea
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  • Hyeon Chang Kim
    Correspondence
    Reprint requests Address requests for reprints to: Hyeon Chang Kim, MD, PhD, Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. fax: +82-2-392-8133.
    Affiliations
    Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
Published:December 18, 2020DOI:https://doi.org/10.1016/j.cgh.2020.12.022

      Background & Aims

      An international expert panel proposed a new definition for metabolic dysfunction–associated fatty liver disease (MAFLD) as a name change from nonalcoholic fatty liver disease (NAFLD). The clinical impact of this change on the assessment of cardiovascular disease (CVD) risk is yet unknown. We evaluated the prevalence of fatty liver disease (FLD) and the associated CVD risk using each of these definitions.

      Methods

      From a nationwide health screening database, we included 9,584,399 participants (48.5% male) aged 40-64 years between 2009 and 2010. Participants were categorized by presence of NAFLD and MAFLD, separately, and by the combination of the 2 definitions—Neither-FLD, NAFLD-only, MAFLD-only, or Both-FLD. The primary outcome was a composite CVD event, including myocardial infarction, ischemic stroke, heart failure, or CVD-related death.

      Results

      The prevalence of NAFLD and MAFLD was 28.0% and 37.3%, respectively. After excluding those with prior CVD, 8,962,813 participants were followed for a median of 10.1 years. NAFLD and MAFLD were each associated with significantly higher risk for CVD events. When the Neither-FLD group was the reference, multivariable-adjusted hazard ratios (95% confidence interval) for CVD events were 1.09 (1.03-1.15) in the NAFLD-only group, 1.43 (1.41-1.45) in the MAFLD-only group, and 1.56 (1.54-1.58) in the Both-FLD group.

      Conclusions

      A considerable proportion of middle-aged Korean adults have MAFLD without satisfying the former definition of NAFLD. The change from NAFLD to MAFLD criteria may identify a greater number of individuals with metabolically complicated fatty liver and increased risk for CVD.

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      ASCVD (atherosclerotic cardiovascular disease), CCI (Charlson Comorbidity Index), CI (confidence interval), CVD (cardiovascular disease), FLD (fatty liver disease), FLI (fatty liver index), HR (hazard ratio), ICD-10 (International Classification of Diseases–Tenth Revision), MAFLD (metabolic dysfunction–associated fatty liver disease), MI (myocardial infarction), NAFLD (nonalcoholic fatty liver disease), NHIS (National Health Insurance Service)
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