MAFLD Criteria May Overlook a Subtype of Patient with Steatohepatitis and Significant Fibrosis

Abstract

Introduction

Metabolic associated fatty liver disease (MAFLD) is a novel concept for fatty liver disease. Different from non-alcoholic fatty liver disease (NAFLD), the diagnosis of MAFLD requires the presence of metabolic risks. This study aimed to characterize patients with liver steatosis but without metabolic risks (non-MR-steatosis) which may not be diagnosed by MAFLD criteria.

Methods

Consecutive patients who underwent biopsy were included in this study. The clinic-pathological characteristics of non-MR-steatosis, NAFLD and MAFLD were compared.

Results

A total of 1217 cases were included. There were 426 (35.00%) cases with MAFLD, 585 (48.07%) with NAFLD and 168 (13.80%) with non-MR-steatosis. The majority of the cases were infected with HBV (93.26%). The age and metabolic profiles were highest in MAFLD and lowest in non-MR-steatosis. The body mass index (BMI) level was also lowest in non-MR-steatosis (20.78 ± 1.54 kg/m²). The ALT and AST levels of the non-MR-steatosis group were not statistically different from those of MAFLD or NAFLD groups (p > 0.05). Histologically, there was no significant difference in the degrees of inflammation and fibrosis among the three groups. The severity of steatosis in non-MR-steatosis group was lower than MAFLD or NAFLD groups (p < 0.05). These results were consistent in both HBV and non-HBV subgroups.

Conclusion

MAFLD criteria may overlook some steatotic patients without metabolic risks, who may also have steatohepatitis and significant fibrosis.

Keywords:

• metabolic associated fatty liver disease
• nonalcoholic fatty liver disease
• metabolic risks
• lean NAFLD
• biopsy

Abbreviations

FLD, fatty liver disease; MAFLD, metabolic associated fatty liver disease; NAFLD, nonalcoholic fatty liver disease; Non-MR-steatosis, Non-metabolic risks NAFLD; NAS, NAFLD activity score; BMI, body mass index; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, γ-glutamyl transpeptidase; eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglyceride; TC, total cholesterol; VLDL-C, very low-density lipoprotein cholesterol; FPG, fasting plasma glucose; HOMA-IR, homeostasis model assessment-insulin resistance score; CRP, C-reactive protein.

Ethics Approval and Informed Consent

An informed consent was obtained from each participant on admission to use their medical data anonymously. The ethics approval was approved by the First Affiliated Hospital, Fujian Medical University Institution Review Board ([2015]084-1). This study conforms to the principles outlined in the Declaration of Helsinki.

Author Contributions

Jiaofeng Huang and Wenjuan Xue, share first authorship. Study concept and design: Jiaofeng Huang and Su Lin

Acquisition, cleaning of data: Wenjuan Xue and Mingfang Wang

Drafting of the manuscript: Su Lin and Jiaofeng Huang

Critical revision: Rahul Kumar, Yueyong Zhu, Medha Singh and Yinlian Wu

Statistical analysis: Jiaofeng Huang and Wenjuan Xue

Study supervision: Su Lin

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This research is supported by Qingzhong Medical Science Research Fund (B17344) and Startup Fund for scientific research, Fujian Medical University (2018QH1047).