An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD

Grace En Hui Lim; Ansel Tang; Cheng Han Ng; Yip Han Chin; Wen Hui Lim; Darren Jun Hao Tan; Jie Ning Yong; Jieling Xiao; Chloe Wen Min Lee; Mark Chan; Nicholas WS Chew; Eunice Xiang Xuan Tan; Mohammad Shadab Siddiqui; Daniel Huang; Mazen Noureddin; Arun J. Sanyal; Mark D. Muthiah

doi:10.1016/j.cgh.2021.11.038

An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD

Grace En Hui Lim, Ansel Tang, Cheng Han Ng, Yip Han Chin, Wen Hui Lim, Darren Jun Hao Tan, Jie Ning Yong, Jieling Xiao, Chloe Wen Min Lee, Mark Chan, Nicholas WS Chew, Eunice Xiang Xuan Tan, Mohammad Shadab Siddiqui, Daniel Huang, Mazen Noureddin, Arun J. Sanyal, Mark D. Muthiah

Houston Methodist

Research output: Contribution to journal › Review article › peer-review

93 Scopus citations

Abstract

BACKGROUND & AIMS: The shift to redefine nonalcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) can profoundly affect patient care, health care professionals, and progress within the field. To date, there remains no consensus on the characterization of NAFLD vs MAFLD. Thus, this study sought to compare the differences between the natural history of NAFLD and MAFLD.

METHODS: Medline and Embase databases were searched to include articles on prevalence, risk factors, or outcomes of patients with MAFLD or NAFLD. Meta-analysis of proportions was conducted using the generalized linear mix model. Risk factors and outcomes were evaluated in conventional pairwise meta-analysis.

RESULTS: Twenty-two articles involving 379,801 patients were included. Pooled prevalence of MAFLD was 39.22% (95% confidence interval [CI], 30.96%-48.15%) with the highest prevalence in Europe and Asia, followed by North America. The current MAFLD Definition only accounted for 81.59% (95% CI, 66.51%-90.82%) of NAFLD diagnoses. Patients had increased odds of being diagnosed with MAFLD compared with NAFLD (odds ratio, 1.37; 95% CI, 1.16-1.63; P < .001). Imaging modality resulted in a significantly higher odds of being diagnosed with MAFLD compared with NAFLD, but not biopsy. MAFLD was significantly associated with males, higher body mass index, hypertension, diabetes, lipids, transaminitis, and greater fibrosis scores compared with NAFLD.

CONCLUSIONS: There were stark differences in the prevalence and risk factors between MAFLD and NAFLD. However, in the use of the MAFLD Definition, a greater emphasis on the management of concomitant metabolic diseases and a collaborative effort is required to explore the complex pathophysiologic mechanisms underlying the disease.

Original language	English (US)
Pages (from-to)	619-629.e7
Journal	Clinical Gastroenterology and Hepatology
Volume	21
Issue number	3
DOIs	https://doi.org/10.1016/j.cgh.2021.11.038
State	Published - Mar 2023

Keywords

Liver Diseases
Metabolic Associated Fatty Liver Disease
Nonalcoholic Fatty Liver Disease
Prevalence
Risk Factors
Asia
Biopsy
Humans
Non-alcoholic Fatty Liver Disease
Male

ASJC Scopus subject areas

Gastroenterology
Hepatology

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10.1016/j.cgh.2021.11.038

Cite this

Lim, G. E. H., Tang, A., Ng, C. H., Chin, Y. H., Lim, W. H., Tan, D. J. H., Yong, J. N., Xiao, J., Lee, C. W. M., Chan, M., Chew, N. WS., Xuan Tan, E. X., Siddiqui, M. S., Huang, D., Noureddin, M., Sanyal, A. J., & Muthiah, M. D. (2023). An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD. Clinical Gastroenterology and Hepatology, 21(3), 619-629.e7. https://doi.org/10.1016/j.cgh.2021.11.038

Lim, GEH, Tang, A, Ng, CH, Chin, YH, Lim, WH, Tan, DJH, Yong, JN, Xiao, J, Lee, CWM, Chan, M, Chew, NWS, Xuan Tan, EX, Siddiqui, MS, Huang, D, Noureddin, M, Sanyal, AJ & Muthiah, MD 2023, 'An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD', Clinical Gastroenterology and Hepatology, vol. 21, no. 3, pp. 619-629.e7. https://doi.org/10.1016/j.cgh.2021.11.038

@article{26a0f6a20ca440c98dc54a6b48afaf60,

title = "An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD",

abstract = "BACKGROUND & AIMS: The shift to redefine nonalcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) can profoundly affect patient care, health care professionals, and progress within the field. To date, there remains no consensus on the characterization of NAFLD vs MAFLD. Thus, this study sought to compare the differences between the natural history of NAFLD and MAFLD.METHODS: Medline and Embase databases were searched to include articles on prevalence, risk factors, or outcomes of patients with MAFLD or NAFLD. Meta-analysis of proportions was conducted using the generalized linear mix model. Risk factors and outcomes were evaluated in conventional pairwise meta-analysis.RESULTS: Twenty-two articles involving 379,801 patients were included. Pooled prevalence of MAFLD was 39.22% (95% confidence interval [CI], 30.96%-48.15%) with the highest prevalence in Europe and Asia, followed by North America. The current MAFLD Definition only accounted for 81.59% (95% CI, 66.51%-90.82%) of NAFLD diagnoses. Patients had increased odds of being diagnosed with MAFLD compared with NAFLD (odds ratio, 1.37; 95% CI, 1.16-1.63; P < .001). Imaging modality resulted in a significantly higher odds of being diagnosed with MAFLD compared with NAFLD, but not biopsy. MAFLD was significantly associated with males, higher body mass index, hypertension, diabetes, lipids, transaminitis, and greater fibrosis scores compared with NAFLD.CONCLUSIONS: There were stark differences in the prevalence and risk factors between MAFLD and NAFLD. However, in the use of the MAFLD Definition, a greater emphasis on the management of concomitant metabolic diseases and a collaborative effort is required to explore the complex pathophysiologic mechanisms underlying the disease.",

keywords = "Liver Diseases, Metabolic Associated Fatty Liver Disease, Nonalcoholic Fatty Liver Disease, Prevalence, Risk Factors, Asia, Biopsy, Humans, Non-alcoholic Fatty Liver Disease, Male",

author = "Lim, {Grace En Hui} and Ansel Tang and Ng, {Cheng Han} and Chin, {Yip Han} and Lim, {Wen Hui} and Tan, {Darren Jun Hao} and Yong, {Jie Ning} and Jieling Xiao and Lee, {Chloe Wen Min} and Mark Chan and Chew, {Nicholas WS} and {Xuan Tan}, {Eunice Xiang} and Siddiqui, {Mohammad Shadab} and Daniel Huang and Mazen Noureddin and Sanyal, {Arun J.} and Muthiah, {Mark D.}",

note = "Funding Information: Grace En Hui Lim (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Ansel Tang (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Cheng Han Ng (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Yip Han Chin (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal; Writing – review & editing: Equal), Wen Hui Lim (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal; Writing – review & editing: Equal), Darren Jun Hao Tan (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal), Jie Ning Yong (Conceptualization: Equal; Data curation: Equal; Writing – original draft: Equal), Jieling Xiao (Conceptualization: Equal; Data curation: Equal; Writing – original draft: Equal), Chloe Wen-Min Lee (Conceptualization: Equal; Data curation: Equal; Writing – original draft: Equal), Mark Chan (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Nicholas WS Chew (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Eunice Xiang Xuan Tan (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mohammad Shadab Siddiqui (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Daniel Huang (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mazen Noureddin (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mark Dhinesh Muthiah (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Arun J. Sanyal (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal) Funding Information: Conflicts of interest The authors disclose the following: Arun J. Sanyal is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect; and Galmed; has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz, and Genfit; has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen, and Bristol Myers Squibb; and receives royalties from Elsevier and UptoDate; his institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland, and Norvatis. Mazen Noureddin has been on the advisory board for 89BIO, Gilead, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Terns, Siemens, and Roche diagnostic; has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking, and Zydus; and is a minor shareholder or has stocks in Anaetos, Rivus Pharma, and Viking. The remaining authors disclose no conflicts. Publisher Copyright: {\textcopyright} 2023 AGA Institute",

year = "2023",

month = mar,

doi = "10.1016/j.cgh.2021.11.038",

language = "English (US)",

volume = "21",

pages = "619--629.e7",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders Ltd",

number = "3",

}

TY - JOUR

T1 - An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD

AU - Lim, Grace En Hui

AU - Tang, Ansel

AU - Ng, Cheng Han

AU - Chin, Yip Han

AU - Lim, Wen Hui

AU - Tan, Darren Jun Hao

AU - Yong, Jie Ning

AU - Xiao, Jieling

AU - Lee, Chloe Wen Min

AU - Chan, Mark

AU - Chew, Nicholas WS

AU - Xuan Tan, Eunice Xiang

AU - Siddiqui, Mohammad Shadab

AU - Huang, Daniel

AU - Noureddin, Mazen

AU - Sanyal, Arun J.

AU - Muthiah, Mark D.

N1 - Funding Information: Grace En Hui Lim (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Ansel Tang (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Cheng Han Ng (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Yip Han Chin (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal; Writing – review & editing: Equal), Wen Hui Lim (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal; Writing – review & editing: Equal), Darren Jun Hao Tan (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Writing – original draft: Equal), Jie Ning Yong (Conceptualization: Equal; Data curation: Equal; Writing – original draft: Equal), Jieling Xiao (Conceptualization: Equal; Data curation: Equal; Writing – original draft: Equal), Chloe Wen-Min Lee (Conceptualization: Equal; Data curation: Equal; Writing – original draft: Equal), Mark Chan (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Nicholas WS Chew (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Eunice Xiang Xuan Tan (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mohammad Shadab Siddiqui (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Daniel Huang (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mazen Noureddin (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Mark Dhinesh Muthiah (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal), Arun J. Sanyal (Conceptualization: Equal; Supervision: Equal; Validation: Equal; Writing – review & editing: Equal) Funding Information: Conflicts of interest The authors disclose the following: Arun J. Sanyal is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect; and Galmed; has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz, and Genfit; has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen, and Bristol Myers Squibb; and receives royalties from Elsevier and UptoDate; his institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland, and Norvatis. Mazen Noureddin has been on the advisory board for 89BIO, Gilead, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Terns, Siemens, and Roche diagnostic; has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking, and Zydus; and is a minor shareholder or has stocks in Anaetos, Rivus Pharma, and Viking. The remaining authors disclose no conflicts. Publisher Copyright: © 2023 AGA Institute

PY - 2023/3

Y1 - 2023/3

N2 - BACKGROUND & AIMS: The shift to redefine nonalcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) can profoundly affect patient care, health care professionals, and progress within the field. To date, there remains no consensus on the characterization of NAFLD vs MAFLD. Thus, this study sought to compare the differences between the natural history of NAFLD and MAFLD.METHODS: Medline and Embase databases were searched to include articles on prevalence, risk factors, or outcomes of patients with MAFLD or NAFLD. Meta-analysis of proportions was conducted using the generalized linear mix model. Risk factors and outcomes were evaluated in conventional pairwise meta-analysis.RESULTS: Twenty-two articles involving 379,801 patients were included. Pooled prevalence of MAFLD was 39.22% (95% confidence interval [CI], 30.96%-48.15%) with the highest prevalence in Europe and Asia, followed by North America. The current MAFLD Definition only accounted for 81.59% (95% CI, 66.51%-90.82%) of NAFLD diagnoses. Patients had increased odds of being diagnosed with MAFLD compared with NAFLD (odds ratio, 1.37; 95% CI, 1.16-1.63; P < .001). Imaging modality resulted in a significantly higher odds of being diagnosed with MAFLD compared with NAFLD, but not biopsy. MAFLD was significantly associated with males, higher body mass index, hypertension, diabetes, lipids, transaminitis, and greater fibrosis scores compared with NAFLD.CONCLUSIONS: There were stark differences in the prevalence and risk factors between MAFLD and NAFLD. However, in the use of the MAFLD Definition, a greater emphasis on the management of concomitant metabolic diseases and a collaborative effort is required to explore the complex pathophysiologic mechanisms underlying the disease.

AB - BACKGROUND & AIMS: The shift to redefine nonalcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) can profoundly affect patient care, health care professionals, and progress within the field. To date, there remains no consensus on the characterization of NAFLD vs MAFLD. Thus, this study sought to compare the differences between the natural history of NAFLD and MAFLD.METHODS: Medline and Embase databases were searched to include articles on prevalence, risk factors, or outcomes of patients with MAFLD or NAFLD. Meta-analysis of proportions was conducted using the generalized linear mix model. Risk factors and outcomes were evaluated in conventional pairwise meta-analysis.RESULTS: Twenty-two articles involving 379,801 patients were included. Pooled prevalence of MAFLD was 39.22% (95% confidence interval [CI], 30.96%-48.15%) with the highest prevalence in Europe and Asia, followed by North America. The current MAFLD Definition only accounted for 81.59% (95% CI, 66.51%-90.82%) of NAFLD diagnoses. Patients had increased odds of being diagnosed with MAFLD compared with NAFLD (odds ratio, 1.37; 95% CI, 1.16-1.63; P < .001). Imaging modality resulted in a significantly higher odds of being diagnosed with MAFLD compared with NAFLD, but not biopsy. MAFLD was significantly associated with males, higher body mass index, hypertension, diabetes, lipids, transaminitis, and greater fibrosis scores compared with NAFLD.CONCLUSIONS: There were stark differences in the prevalence and risk factors between MAFLD and NAFLD. However, in the use of the MAFLD Definition, a greater emphasis on the management of concomitant metabolic diseases and a collaborative effort is required to explore the complex pathophysiologic mechanisms underlying the disease.

KW - Liver Diseases

KW - Metabolic Associated Fatty Liver Disease

KW - Nonalcoholic Fatty Liver Disease

KW - Prevalence

KW - Risk Factors

KW - Asia

KW - Biopsy

KW - Humans

KW - Non-alcoholic Fatty Liver Disease

KW - Male

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U2 - 10.1016/j.cgh.2021.11.038

DO - 10.1016/j.cgh.2021.11.038

M3 - Review article

C2 - 34871813

AN - SCOPUS:85123740722

SN - 1542-3565

VL - 21

SP - 619-629.e7

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 3

ER -

An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD

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