Li, Yan, Dai, Changyong, Ruan, Yuhua, Yang, Haiqing, Zeng, Huang, Huang, Rui, Wang, Jialu, Dai, Mingjia, Hao, Jungui, Wang, Liping, Li, Jie, Yan, Xuebing, Lu, Zhonghua, and Ji, Fang
Background The evaluation of patients with fatty liver as defined by metabolic dysfunction-associated fatty liver disease (MAFLD) in the real world remains poorly researched. This study aimed to analyse the clinical and histological features of patients with MAFLD and nonalcoholic fatty liver disease (NAFLD) and to characterize each metabolic subgroup of MAFLD. Methods A total of 2563 patients with fatty liver confirmed by ultrasonography and/or magnetic resonance tomography and/or liver biopsy-proven from three hospitals in China were included in the study. Patients were divided into different groups according to diagnostic criteria for MAFLD and NAFLD, and MAFLD into different subgroups. Results There were 2337 (91.2%) patients fitting the MAFLD criteria, and 2095 (81.7%) fitting the NAFLD criteria. Compared to patients with NAFLD, those with MAFLD were more likely to be male, had more metabolic traits, higher liver enzyme levels, and noninvasive fibrosis scores. Among the patients with liver biopsy, the extent of advanced fibrosis in cases with MAFLD was significantly higher than those with NAFLD, 31.8% versus 5.2% (P < .001); there was no significant difference in advanced fibrosis between obese cases and lean individuals in MAFLD (P > .05); MAFLD complicated with diabetes had significantly higher advanced fibrosis than those without diabetes (43.3% and 17.2%, respectively; P < .001). Conclusions Patients with MAFLD have a higher degree of liver fibrosis than NAFLD patients. In addition, diabetic patients should be screened for fatty liver and liver fibrosis degree. Key message What is already known on this topic Nonalcoholic fatty liver disease (NAFLD) is now the most common chronic liver disease worldwide. Metabolic dysfunction-associated fatty liver disease (MAFLD) is a novel diagnostic criterion proposed in 2020. Based on the opportunities and challenges brought by the renaming of NAFLD to MAFLD, it is necessary to further describe the clinical and pathological features of the population with criteria for the diagnosis of MAFLD. What this study adds The risk of advanced fibrosis in MAFLD patients who underwent liver biopsy was significantly higher than in NAFLD patients. Lean individuals were not protected from MAFLD. The prevalence of advanced fibrosis was significantly higher in MAFLD patients with diabetes (43.3%), suggesting that patients with diabetes should be screened for fatty liver and degree of liver fibrosis. How this study might affect research, practice, or policy Further validation of MAFLD diagnostic terminology to identify more high-risk patients in clinical practice enables clinicians to optimize the management of liver disease-related comorbidities for future treatment of fatty liver. To describe the incidence of advanced liver fibrosis in patients with MAFLD and diabetes mellitus for early management and treatment. [ABSTRACT FROM AUTHOR]