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

Xiaoning Chen; Zhan Chen; Lingping Jiang; Jiaofeng Huang; Yueyong Zhu; Su Lin

doi:10.1016/j.numecd.2022.11.007

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

Nutr Metab Cardiovasc Dis. 2023 Feb;33(2):376-384. doi: 10.1016/j.numecd.2022.11.007. Epub 2022 Nov 9.

Authors

Xiaoning Chen¹, Zhan Chen¹, Lingping Jiang¹, Jiaofeng Huang¹, Yueyong Zhu², Su Lin³

Affiliations

¹ 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.
² 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. Electronic address: zhuyueyong@fjmu.edu.cn.
³ 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. Electronic address: sumer5129@fjmu.edu.cn.

PMID: 36599780
DOI: 10.1016/j.numecd.2022.11.007

Abstract

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: Cardiovascular risk stratification; Framingham general equations; MAFLD; Mortality; NHANES Ⅲ.

Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiovascular System*
Heart Disease Risk Factors
Humans
Middle Aged
Non-alcoholic Fatty Liver Disease*
Nutrition Surveys
Social Group