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Original article Comparison of all-cause mortality associated with non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease
Wei-Chun Cheng1,2orcid , Hua-Fen Chen3,5orcid , Hsiu-Chi Cheng4orcid , Chung-Yi Li1,6orcid
Epidemiol Health 2024;e2024024
DOI: https://doi.org/10.4178/epih.e2024024 [Accepted]
Published online: January 21, 2024
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1Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Department of Gastroenterology and Hepatology, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
3Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
4Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
5School of Medicine and Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City, Taiwan
6Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
Corresponding author:  Chung-Yi Li,
Email: cyli99@mail.ncku.edu.tw
Received: 15 September 2023   • Revised: 2 January 2024   • Accepted: 4 January 2024

OBJECTIVES
The global burden of non-alcoholic fatty liver disease (NAFLD) is rising. An alternative term, metabolic dysfunction-associated fatty liver disease (MAFLD), instead highlights the associated metabolic risks. This cohort study examined patient classifications under NAFLD and MAFLD criteria and their associations with all-cause mortality.
METHODS
Participants who attended a paid health checkup (2012-2015) were included. Hepatic steatosis (HS) was diagnosed ultrasonographically. NAFLD was defined as HS without secondary causes, while MAFLD involved HS with overweight/obesity, type 2 diabetes mellitus, or ≥2 metabolic dysfunctions. Mortality was tracked via the Taiwan Death Registry until November 30, 2022.
RESULTS
Of 118,915 participants, 36.9% had NAFLD, 40.2% had MAFLD, and 32.9% met both definitions. Participants with NAFLD alone had lower mortality, and those with MAFLD alone had higher mortality, than individuals with both conditions. After adjustment for potential confounders, the hazard ratios (HRs) for all-cause mortality were 1.08 (95% confidence interval [CI], 0.78-1.48) for NAFLD alone and 1.26 (95% CI, 1.09-1.47) for MAFLD alone, relative to both conditions. Advanced fibrosis conferred greater mortality risk, with HRs of 1.93 (95% CI, 1.44-2.58) and 2.08 (95% CI, 1.61-2.70) for advanced fibrotic NAFLD and MAFLD, respectively. Key mortality risk factors for NAFLD and MAFLD included older age, unmarried status, higher body mass index, smoking, diabetes mellitus, chronic kidney disease, and advanced fibrosis.
CONCLUSIONS
All-cause mortality in NAFLD and/or MAFLD was linked to cardiometabolic covariates, with risk attenuated after multivariable adjustment. A high Fib-4 score, indicating fibrosis, could identify FLD cases involving elevated mortality risk.


Epidemiol Health : Epidemiology and Health