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MAFLD is associated with increased all-cause mortality in low cardiovascular-risk individuals but not in intermediate to high-risk individuals

  • Xiaoning Chen
    Affiliations
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China

    Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian 350001, China
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  • Zhan Chen
    Affiliations
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China

    Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian 350001, China
    Search for articles by this author
  • Lingping Jiang
    Affiliations
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China

    Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian 350001, China
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  • Jiaofeng Huang
    Affiliations
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China

    Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian 350001, China
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  • Yueyong Zhu
    Correspondence
    Corresponding author. No. 20, Chazhong Road, Taijiang District, Fuzhou, Fujian, 350001, China. Fax: +86 591-87981600; +86-591-83356180;
    Affiliations
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China

    Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian 350001, China
    Search for articles by this author
  • Su Lin
    Correspondence
    Corresponding author. No. 20, Chazhong Road, Taijiang District, Fuzhou, Fujian, 350001, China. Fax: +86 591-87981600; +86-591-83356180;
    Affiliations
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China

    Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian 350001, China
    Search for articles by this author
Published:November 09, 2022DOI:https://doi.org/10.1016/j.numecd.2022.11.007
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      Highlights

      • MAFLD was associated with increased all-cause mortality among individuals at low cardiovascular risk rather than those at intermediate or high risk.
      • Cause-specific mortality suggested that MAFLD was associated with higher cancer-related mortality in the low-risk population.
      • This finding emphasizes the urgent need for improving the management of MAFLD in low cardiovascular risk individuals.

      Background and Aims

      Metabolic-associated fatty liver disease (MAFLD) is increasingly recognized as a systematic disease rather than just a liver disease alone, which raises concerns about its long-term impact on different populations. This study aimed to clarify the effects of MAFLD on long-term outcomes among different cardiovascular risk-stratified populations.

      Methods and Results

      Eligible individuals in the Third National Health and Nutrition Examination Surveys (NHANES Ⅲ, 1988-1994) were enrolled. Participants were classified into low, intermediate, or high cardiovascular-risk populations according to the Framingham general equations. Kaplan-Meier survival analysis and Cox regression models were used to investigate the association between MAFLD and long-term outcomes in different cardiovascular-risk populations.
      A total of 8897 adults were enrolled in the final analysis. The median ages in the non-MAFLD and MAFLD groups were 44 and 49 years old, respectively. During a median follow-up of 22.8 years, a total of 2991 deaths were recorded, including 1694 deaths (30.3%) in non-MAFLD and 1297 deaths (39.2%) in MAFLD (P<0.001). In the low cardiovascular-risk population, MAFLD individuals had increased all-cause mortality than non-MAFLD individuals (HR=1.206, 95% CI:1.0338-1.400, P=0.014). However, similar results were not observed in intermediate or high-cardiovascular-risk individuals. Further analysis of cause-specific mortality suggested that MAFLD was associated with higher cancer-related mortality in the low-risk population (HR=1.313, 95% CI:1.000-1.725, P=0.049).

      Conclusions

      MAFLD was associated with increased all-cause mortality among individuals with low cardiovascular risk, rather than those with an intermediate or high cardiovascular risk.

      Keywords

      Abbreviations:

      APRI (aspartate-aminotransferase to platelet ratio index), BMI (body mass index), CVD (cardiovascular disease), FIB-4 (fibrosis-4 index), HDL-C (high-density lipoprotein cholesterol), HR (hazard ratios), MAFLD (metabolic-associated fatty liver disease), NAFLD (nonalcoholic fatty liver disease), NFS (NAFLD fibrosis score), NHANES (National Health and Nutrition Examination Survey)
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