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

Figures & data

Figure 1 The flow chart.

Table 1 Comparison Between MAFLD, NAFLD and Non-MR-Steatosis

Variables	MAFLD	NAFLD	Non-MR-Steatosis	P
				MAFLD vs NAFLD	MAFLD vs Non-MR-Steatosis	NAFLD vs Non-MR-Steatosis
N	426	585	168
Age (years)	40.39 ± 10.97	39.41 ± 11.10	37.05 ± 11.21	0.155	0.001	0.011
Male, n (%)	361 (84.74)	489 (83.59)	133 (79.17)	0.684	0.130	0.223
BMI (kg/m^2)	25.51 ± 2.66	24.17 ± 3.18	20.78 ± 1.54	< 0.001	< 0.001	< 0.001
Waist circumference (cm)	84.10 ± 7.32	84.69 ± 6.82	86.10 ± 5.53	0.740	0.445	0.572
Type 2 diabetes, n (%)	83 (19.48)	81 (13.85)	0 (0)	0.021	< 0.001	< 0.001
Hypertension, n (%)	42 (9.86)	45 (7.69)	4 (2.38)	0.272	0.004	0.022
HBsAg positive, n (%)	366 (85.92)	511 (87.35)	150 (89.29)	0.568	0.337	0.588
Log HBVDNA (IU/mL)	4.88 ± 2.24	4.97 ± 2.20	5.11 ± 2.13	0.536	0.292	0.515
HBeAg positive, n (%)	208 (48.83)	302 (51.62)	97 (57.74)	0.425	0.067	0.182
TBIL (μmolL)	18.44 ± 21.50	18.15 ± 21.4	17.4 ± 21.02	0.916	0.683	0.725
Albumin (g/L)	42.58 ± 4.95	42.52 ± 5.05	42.25 ± 5.24	0.759	0.299	0.389
ALT (U/L)	65 (41, 144)	67 (41, 141.75)	75.5 (40, 138.75)	0.901	0.713	0.771
AST (U/L)	42 (30, 71)	43 (30, 77.75)	45 (32, 82.25)	0.730	0.291	0.400
GGT (U/L)	53 (31, 100)	49 (29, 91)	43 (27, 74)	0.133	0.001	0.024
Creatinine (μmolL)	73.35 ± 13.82	73.77 ± 17.99	74.19 ± 26.07	0.927	0.789	0.729
eGFR (mL/min)	120.87 ± 32.47	121.83 ± 37.01	125.86 ± 47.02	0.875	0.364	0.404
Uric acid (μmolL)	369.22 ± 82.29	362.59 ± 83.01	345.03 ± 81.38	0.239	0.004	0.031
TC (mmol/L)	4.77 ± 1.13	4.74 ± 1.08	4.63 ± 0.87	0.749	0.312	0.411
TG (mmol/L)	1.68 ± 1.24	1.50 ± 1.11	1.07 ± 0.43	< 0.001	< 0.001	< 0.001
LDL-C (mmol/L)	2.90 ± 0.97	2.84 ± 0.94	2.69 ± 0.82	0.457	0.014	0.117
HDL-C (mmol/L)	1.12 ± 0.30	1.19 ± 0.34	1.36 ± 0.38	0.002	0.043	< 0.001
VLDL-C (mmol/L)	0.51 ± 0.38	0.46 ± 0.35	0.29 ± 0.15	0.003	< 0.001	< 0.001
FPG (mmol/L)	5.34 ± 1.42	5.14 ± 1.23	4.71 ± 0.54	0.005	< 0.001	< 0.001
HOMA-IR	3.58 ± 1.81	3.20 ± 1.81	1.97 ± 1.21	0.244	0.001	0.007
CRP (mg/L)	3.61 ± 5.56	3.66 ± 5.21	3.89 ± 4.53	0.928	0.997	0.985
Platelets (×10^9/L)	204.71 ± 64.30	200.89 ± 63.37	193.1 ± 66.78	0.376	0.042	0.139
Histopathological Features
Significant inflammation (G≥3, n (%))	168 (39.44)	234 (40.00)	71 (42.26)	0.908	0.590	0.662
Advanced fibrosis (F≥3, n (%))	157 (36.85)	214 (36.58)	60 (35.71)	0.982	0.869	0.909
Moderate to severe steatosis (S≥2, n (%))	216 (50.70)	260 (44.44)	52 (30.95)	0.057	< 0.001	0.002

Notes: Categorical values are shown as n (%). Continuous variables are shown as mean ± standard deviation or median [interquartile range].

Abbreviations: MAFLD, metabolic associated fatty liver disease; NAFLD, nonalcoholic fatty liver disease; Non-MR-steatosis, non-metabolic risks NAFLD; BMI, body mass index; HBsAg, hepatitis B surface antigen; 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.

Table 2 Comparison Between MAFLD, NAFLD and Non-MR-Steatosis Groups in Non-HBV Population

Variables	MAFLD	NAFLD	Non-MR-Steatosis	P
				MAFLD vs NAFLD	MAFLD vs Non-MR-Steatosis	NAFLD vs Non-MR-Steatosis
N	60	74	18
Age (years)	41.62 ± 15.26	40.01 ± 14.81	37.00 ± 12.85	0.559	0.288	0.488
Male, n (%)	36 (60)	48 (64.86)	13 (72.22)	0.690	0.507	0.753
BMI (kg/m^2)	25.3 ± 3.35	24.20 ± 3.38	20.97 ± 1.25	0.024	< 0.001	< 0.001
Type 2 diabetes, n (%)	17 (28.33)	16 (21.62)	0 (0)	0.487	0.008	0.035
Hypertension, n (%)	16 (26.67)	16 (21.62)	1 (5.56)	0.633	0.100	0.177
TBIL (μmolL)	22.91 ± 25.30	20.84 ± 22.97	12.71 ± 3.19	0.830	0.288	0.316
Albumin (g/L)	44.11 ± 6.34	44.35 ± 6.04	44.26 ± 4.34	0.705	0.746	0.909
ALT (U/L)	85 (48, 144.25)	101 (50, 158)	127 (49.5, 207.5)	0.616	0.454	0.633
AST (U/L)	46 (33.25, 66)	48 (32.5, 78.5)	61 (34, 80.5)	0.729	0.638	0.785
GGT (U/L)	103 (59, 230.25)	105 (53.5, 204)	105 (49, 139.5)	0.708	0.208	0.300
Creatinine (μmolL)	67.32 ± 14.53	67.56 ± 14.95	65.46 ± 17.06	0.891	0.743	0.712
eGFR (mL/min)	136.3 ± 38.63	136.44 ± 39.69	142.19 ± 43.27	0.972	0.694	0.690
Uric acid (μmolL)	356.67 ± 76.29	354.23 ± 80.54	337.93 ± 100.08	0.711	0.190	0.256
TC (mmol/L)	4.91 ± 1.08	4.97 ± 1.07	4.98 ± 0.96	0.688	0.629	0.811
TG (mmol/L)	2.12 ± 2.26	1.97 ± 2.05	1.40 ± 0.29	0.518	0.091	0.216
LDL-C (mmol/L)	2.91 ± 1.04	2.95 ± 1.01	3.08 ± 0.69	0.790	0.581	0.733
HDL-C (mmol/L)	1.13 ± 0.35	1.18 ± 0.37	1.26 ± 0.42	0.616	0.458	0.675
VLDL-C (mmol/L)	0.65 ± 0.51	0.61 ± 0.49	0.35 ± 0.16	0.418	0.006	0.023
FPG (mmol/L)	5.42 ± 1.03	5.27 ± 0.95	4.88 ± 0.44	0.289	0.013	0.062
Platelets (×10^9/L)	240.27 ± 77.17	237.01 ± 74.12	224.86 ± 47.21	0.754	0.440	0.540
Histopathological Features
Significant inflammation (G≥3, n (%))	11 (18.33)	12 (16.22)	2 (11.11)	0.926	0.721	0.729
Advanced fibrosis (F≥3, n (%))	9 (15.00)	10 (13.51)	2 (11.11)	1.000	1.000	1.000
Moderate to severe steatosis (S≥2, n (%))	49 (81.67)	58 (78.38)	12 (66.67)	0.798	0.201	0.357
NAS score	4.38 ± 1.55	4.27 ± 1.59	3.89 ± 1.68	0.712	0.338	0.457

Notes: Categorical values are shown as n (%). Continuous variables are shown as mean ± standard deviation or median [interquartile range].

Abbreviations: MAFLD, metabolic associated fatty liver disease; NAFLD, nonalcoholic fatty liver disease; Non-MR-steatosis, non-metabolic risks NAFLD; BMI, body mass index; HBsAg, hepatitis B surface antigen; 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.

Table 3 Comparison Between MAFLD, NAFLD and Non-MR-Steatosis Groups in HBV-Infected Population

Variables	MAFLD	NAFLD	Non-MR-Steatosis	P
				MAFLD vs NAFLD	MAFLD vs Non-MR-Steatosis	NAFLD vs Non-MR-Steatosis
N	366	511	150
Age (years)	40.19 ± 10.10	39.32 ± 10.47	37.06 ± 11.05	0.208	0.001	0.014
Male, n (%)	325 (88.80)	441 (86.3)	120 (80)	0.320	0.013	0.078
BMI (kg/m^2)	25.54 ± 2.53	24.17 ± 3.16	20.76 ± 1.58	< 0.001	< 0.001	< 0.001
Waist circumference (cm)	84.28 ± 7.43	84.83 ± 6.87	86.10 ± 5.53	0.777	0.524	0.640
Type 2 diabetes, n (%)	66 (18.03)	65 (12.72)	0 (0)	0.037	< 0.001	< 0.001
Hypertension, n (%)	26 (7.10)	29 (5.68)	3 (2.00)	0.472	0.038	0.104
Log HBVDNA (IU/mL)	5.06 ± 2.14	5.13 ± 2.11	5.29 ± 2.01	0.613	0.291	0.463
HBeAg positive, n (%)	163 (44.54)	235 (45.99)	73 (48.67)	0.670	0.392	0.563
TBIL (μmolL)	17.71 ± 20.75	17.78 ± 21.17	17.85 ± 21.94	0.993	0.984	0.989
Albumin (g/L)	42.33 ± 4.64	42.26 ± 4.85	42.05 ± 5.29	0.724	0.326	0.444
ALT (U/L)	62 (40, 142)	65 (39.5, 139)	73 (39.5, 129)	0.959	0.738	0.755
AST (U/L)	42 (30, 72)	42 (30, 77)	44 (32, 81.5)	0.778	0.314	0.401
GGT (U/L)	48 (30, 81)	46 (29, 75)	40 (27, 68)	0.204	0.007	0.056
Creatinine (μmolL)	74.41 ± 13.44	74.65 ± 18.22	74.90 ± 26.59	0.863	0.524	0.589
eGFR (mL/min)	118.15 ± 30.53	119.76 ± 36.18	124.51 ± 47.21	0.657	0.179	0.281
Uric acid (μmolL)	371.38 ± 83.19	363.75 ± 83.36	345.60 ± 80.09	0.233	0.005	0.044
TC (mmol/L)	4.74 ± 1.14	4.71 ± 1.08	4.6 ± 0.86	0.676	0.289	0.424
TG (mmol/L)	1.61 ± 0.96	1.44 ± 0.88	1.03 ± 0.43	< 0.001	< 0.001	< 0.001
LDL-C (mmol/L)	2.89 ± 0.95	2.83 ± 0.93	2.65 ± 0.83	0.376	0.023	0.083
HDL-C (mmol/L)	1.12 ± 0.3	1.20 ± 0.34	1.37 ± 0.38	0.002	< 0.001	< 0.001
VLDL-C (mmol/L)	0.49 ± 0.35	0.44 ± 0.32	0.28 ± 0.15	0.005	< 0.001	< 0.001
FPG (mmol/L)	5.32 ± 1.47	5.12 ± 1.27	4.68 ± 0.55	0.011	< 0.001	< 0.001
HOMA-IR	3.53 ± 1.84	3.15 ± 1.82	1.97 ± 1.21	0.252	0.001	0.011
CRP (mg/L)	2.78 ± 5.03	3.01 ± 4.71	3.40 ± 4.53	0.587	0.711	0.758
Platelets (×10^9/L)	198.87 ± 60.06	195.76 ± 60.03	189.75 ± 67.79	0.467	0.071	0.180
Histopathological Features
Significant inflammation (G≥3, n (%))	157 (42.90)	222 (43.44)	69 (46.00)	0.926	0.584	0.645
Advanced fibrosis (F≥3, n (%))	148 (40.44)	204 (39.92)	58 (38.67)	0.933	0.784	0.856
Moderate to severe steatosis (S≥2, n (%))	167 (45.63)	202 (39.53)	40 (26.67)	0.083	< 0.001	0.005

Notes: Categorical values are shown as n (%). Continuous variables are shown as mean ± standard deviation or median [interquartile range].

Abbreviations: MAFLD, metabolic associated fatty liver disease; NAFLD, nonalcoholic fatty liver disease; Non-MR-steatosis, non-metabolic risks NAFLD; BMI, body mass index; HBsAg, hepatitis B surface antigen; 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.