Yu‑Ming Chenga†, Shao‑Wen Wangb†, Chia‑Chi Wangc,d*, Jia‑Horng Kaoe,f
aDepartment of Gastroenterology and Hepatology, Tung’s Taichung MetroHarbor Hospital, Taichung, Taiwan, bDepartment of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, cDepartment of Gastroenterology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, dSchool of Medicine, Tzu Chi University, Hualien, Taiwan, eDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, fGraduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
†Both authors contributed equally to this work.
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: Metabolic‑associated fatty liver disease (MAFLD) was proposed in 2020 to replace the original term nonalcoholic fatty liver disease (NAFLD) with new diagnostic criteria. The disease risks of lean and overweight/obese MAFLD patients remain controversial. Materials and Methods: The participants from the Taiwan biobank cohort were included. Advanced liver fibrosis is defined as NAFLD fibrosis score (NFS) >0.675. We use carotid plaques of duplex ultrasounds to diagnose atherosclerosis. Results: A total of 20,058 participants (age 55.67 ± 10.32; males 37.6%) were included in the final analysis. Seven thousand eight hundred and forty‑three (39.1%) participants were diagnosed with MAFLD. Of them, 965 (12.3%) were lean MAFLD patients. Among lean MAFLD patients, 25.6% were comorbid with diabetes mellitus (DM). Lean MAFLD patients were older and had higher percentages of females and DM than overweight/obese MAFLD patients. After propensity score matching for age and sex, they had lower levels of NFS but a higher percentage of carotid plaques. Among four subtypes of MAFLD including “lean with DM,” “lean without DM,” “overweight/obese with DM,” and “overweight/obese without DM,” logistic regression showed that “lean with DM” subjects had the highest risk of atherosclerosis and “overweight/obese with DM” subjects had the highest risk of advanced liver fibrosis in MAFLD patients. Conclusion: The population‑based study revealed that lean MAFLD patients make up 12.3% of all MAFLD patients, and they have a higher proportion of coexisting diabetes. Among lean MAFLD patients concurrent with diabetes, they have the highest risk of atherosclerosis and should receive special attention clinically.
Keywords: Carotid artery plaque, Liver fibrosis, Metabolic‑associated fatty liver disease, Nonalcoholic fatty liver disease, Nonalcoholic fatty liver disease fibrosis score
