FIRST RESULTS OF THE EVOLUTION AND THE INFLUENCE OF STATIN TREATMENT ON NAFLD IN A PRIMARY CARE COHORT OVER A 2-YEAR PERIOD

Abstract

Background: A novel term, metabolic dysfunction-associated fatty liver disease (MAFLD), was proposed by a group of experts. However, it remains unclear whether hepatic steatosis per se in MAFLD contributes to an elevated risk of mortality in individual's with overweight/obesity, metabolic dysregulation, or type 2 diabetes mellitus (DM) (referred to as the metabolic dysfunction-association (MA) group), which are known significant risk factors for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the 'MAFLD' group and the 'MA without fatty liver' group. Methods: A total of 10,052 participants from NHANES III were included. Fatty liver was diagnosed using ultrasound, and MAFLD was defined based on the criteria proposed by an international panel of experts. Mortality risks were compared between the 'MAFLD' group and the 'MA without fatty liver' group using the Cox proportional hazards model with complex survey design weights, adjusted for demographic and anthropometry factors (age, sex, race, body mass index and waist circumference), social history (education, marriage status, smoking and alcohol history and exercise) and comorbidity variables (hypertension, DM and hyperlipidemia). Linked mortality data, including all-cause, cancer, cardiovascular, and other causes-related mortality, were examined from 1988 through 2019. For liver-related mortality, data were evaluated from 1988 through 2006. Results: Over an average follow-up period of 23.0 years, the 'MAFLD' group did not exhibit a significant increase in all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.07 [0.99-1.16], P = 0.100), cancer mortality (1.08 [0.86-1.36], P = 0.508), or cardiovascular mortality (0.89 [0.78-1.02], P = 0.084) compared to the 'MA without fatty liver' group. However, other causes-related mortality , which included liver-related mortality, was higher in the MAFLD group (1.36 [1.14-1.62], P = 0.001). This trend persisted in sensitivity analyses conducted on participants without viral hepatitis or heavy alcohol consumption. No significant effect modification was observed according to subgroups. Liver-related mortality , assessed over a 13.8-year follow-up period, showed a marginal increase in the 'MAFLD' group (2.49 [0.99-6.23], P = 0.052) compared to the 'MA without fatty liver' group. Conclusion: The 'MAFLD' group did not demonstrate an elevated risk of all-cause, cardiovas-cular, or cancer mortality when compared to the 'MA without fatty liver' group. However, there was a trend toward an increased risk of liver-related mortality in the MAFLD group.