ARE FATTY LIVER PATIENTS WHO INITIALLY FAIL TO MEET METABOLIC ASSOCIATED FATTY LIVER DISEASE CRITERIA PART OF ITS SPECTRUM?

Gacrama, Paul Martin

Background: The recent change in diagnostic criteria for fatty liver disease has resulted in changes in epidemiology. We aimed to compare the clinical, biochemical, and metabolic differences among patients with fatty liver who met either nonalcoholic (non-MAFLD NAFLD) or metabolic associated fatty liver (non-NAFLD MAFLD) alone, or both (NAFLD/MAFLD), or none (non-NAFLD/MAFLD), and to report on the incidence of non-MAFLD patients eventually meeting MAFLD criteria on follow-up.

Methodology: Consecutive patients with fatty liver on ultrasound from March 2007 to July 2017 were included. Only patients who had at least 2 follow-up visits were included in determining the incidence of non-MAFLD NAFLD and non-NAFLD/MAFLD patients progressing to MAFLD.

Results: The distribution of patients was 3.9% (N=26) non-NAFLD/MAFLD, 7.8% (N=52) non-MAFLD NAFLD, 74.5% (N=494) NAFLD/MAFLD, and 13.7% (N=91) non-NAFLD MAFLD. All patients in the non-NAFLD MAFLD and non-NAFLD/MAFLD groups had HBsAg positivity. As expected, NAFLD/MAFLD and non-NAFLD MAFLD patients were more likely to be hypertensive, with dyslipidemia and cardiovascular/cerebrovascular diseases, and have higher alanine aminotransferase (ALT) levels compared to the other 2 groups (p<0.05). NAFLD/MAFLD patients were more likely to be older and to have higher total cholesterol, triglyceride levels and NAFLD fibrosis score compared to the other groups. After a median follow-up of 39.6 weeks, 4.8% (1/21) and 21.9% (7/32) of eligible non-NAFLD/MAFLD and non-MAFLD NAFLD patients eventually satisfied MAFLD criteria. These patients were more likely to have baseline cirrhosis (50% vs. 4.4%; p=0.003), older (63.3 vs. 50; p=0.007) and have higher creatinine (1.1 vs. 0.8mg/dL; p=0.002) compared to patients who did not meet MAFLD criteria.

Conclusion: Majority of fatty liver patients met both NAFLD and MAFLD criteria. Our data shows that fatty liver patients who do not meet MAFLD criteria initially, especially HBsAg negative patients, need close monitoring of risk factors because a fifth will eventually meet MAFLD criteria.

Keywords: Metabolic associated fatty liver disease; Non-alcoholic fatty liver disease

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