- •Prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) was high (36%).
- •Prevalence of MAFLD increased significantly in the past three decades.
- •Prevalence of metabolic unhealthy non-diabetes subtype was the highest, followed by mixed subtype.
- •MAFLD was associated with an increased all-cause or cardiovascular mortality.
- •A significant impact of metabolic parameters on the relationship between MAFLD and all-cause mortality was demonstrated.
Given the escalating epidemic of obesity and diabetes coupled with redefined diagnostic criteria, it is critical to identify the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD). We sought to determine the prevalence and mortality outcomes of MAFLD subtypes based on diagnostic criteria in the USA over the past three decades.
Eleven cycles of the National Health and Nutrition Examination Surveys (NHANES; 1988–1994 and 1999–2020) were used, and 72,224 participants were included. MAFLD was defined according to the 2020 International Expert Consensus. Based on diagnostic criteria and risk factors, MAFLD was categorized into seven subtypes: type 1 (obesity subtype), 2 (metabolic unhealthy subtype), 3 (diabetes subtype), 4 (metabolic unhealthy non-diabetes subtype), 5 (obesity and diabetes subtype), 6 (metabolic unhealthy non-obesity subtype), and 7 (mixed subtype).
Over the study period, the estimated prevalence of MAFLD increased significantly from 22% in 1988–1994 to 36% in 2017–2020. The prevalence of Type 4 was the highest, followed by that of Type 7, whereas other types were low and almost unchanged over time. Individuals with MAFLD had 19% and 38% increased mortality risks from all causes and cardiovascular disease, respectively. Among them, the metabolically unhealthy participants with normal weight demonstrated a 116% higher risk for all-cause mortality [hazard ratio (HR): 2.16, 95% CI: 1.52–3.08] and a 222% higher risk for cardiovascular mortality (HR: 3.22, 95% CI: 1.72–6.04). Interestingly, stratification and interaction analyses demonstrated a significant impact of metabolic parameters on the relationship between MAFLD and all-cause mortality.
In conclusion, our study identified an increase in MAFLD prevalence and a significant association between metabolic derangements in MAFLD and all-cause or cardiovascular mortality.
Abbreviations:ACM (all-cause mortality), ALT (alanine aminotransferase), AST (aspartate aminotransferase), ALB (albumin), BMI (body mass index), 95%CI (95% confidence interval), GGT (gamma glutamyl transferase), HBP (high blood pressure), HDL (high-density lipoprotein), HR (hazard ratio), MAFLD (metabolic dysfunction-associated fatty liver disease), NHANES (National Health and Nutrition Examination Survey), SE (standard error), TC (total cholesterol), T2DM (Type 2 diabetic mellitus), US-FLI (US-Fatty Liver Index)
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Published online: February 06, 2023
Accepted: January 21, 2023
Received in revised form: January 19, 2023
Received: September 8, 2022
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