Perfect Concordance Between NAFLD and MAFLD in Veteran Patient Population

Aaron P. Thrift, PhD

New research shows a perfect match between non-alcoholic fatty liver disease (NAFLD) and metabolic associated fatty liver disease (MAFLD) in a cohort of veteran patients.

A team, led by Aaron P. Thrift, Section of Epidemiology and Population Sciences, Baylor College of Medicine, estimated the burden of and risk factors for both NAFLD and MAFLD and examined the concordance between definitions of the 2 diseases in a population of Veteran patients.

The Study

In the cross-sectional study, the investigators randomly selected patients within primary care at Houston Veterans Affairs hospitals. Each participant completed a survey, provided blood samples, and underwent a Fibroscan. The mean age of the patient population was 50.9 years. In addition, 55.4% of the patient population were women, 42.8% were white, and 43.8% were Black.

In addition, the patients did not have a history of heavy alcohol use and were not diagnosed with either hepatitis C virus (HCV) or hepatitis B virus (HBV). NAFLD was defined as a controlled attenuation parameter (CAP) median of at least 290 dB/m. MAFLD was defined as a CAP median of at least 290 dB/m and either a body mass index (BMI) of ≥25 kg/m² or diabetes, or 2 or more of the following: hypertension, high triglycerides, low HDL cholesterol, and high LDL cholesterol.

NAFLD and MAFLD

The overall prevalence of NAFLD was 40.6% (n = 82), with every NAFLD patient having a BMI of at least 25, meeting the investigators criteria for MAFLD.

However, patients with more than 3 traits had a 48-fold (adjusted OR, 47.6; 95% CI, 11.3-200) higher risk of NAFLD/MAFLD compared to patients with no metabolic trait. There were also 19 participants (9.4% of the total, 15.9% of NAFLD) with at least moderate fibrosis.

“NAFLD was present in 40% of veterans registered in primary care; 9.4% of Veterans had at least moderate hepatic fibrosis, with most having concurrent NAFLD,” the authors wrote. “There was perfect concordance between NAFLD and the alternative MAFLD definition.”

The Prevalence of NAFLD

A new look at NAFLD data show the disease is increasing worldwide and remains especially high among men.

Overall, the prevalence of NAFLD worldwide was 32.4% (95% CI, 29.9-34.9%). However, the prevalence of the disease has significantly increased over time, from 25.5% (95% CI, 20.1-31.0%) in or before 2005 to 37.8% (95% CI, 32.4-43.3%) in 2016 or later (P = 0.013).

The prevalence of disease was also higher in men (39.7%; 95% CI, 36.6-42.8%) than it was in women (25.6%; 95% CI, 22.3-28.8) (P <0.0001).

The investigators also estimated an overall incidence of NAFLD of 46.9 cases per 1000 person-years. However, the incidence rate was higher in men (70.8 cases per 1000 person-years; 95% CI, 48.7-92.8) than it was in women (46.9 cases per 1000 person-years; 95% CI, 20.2-38.9) (P <0.0001).

There was also considerable heterogeneity between studies focused on NAFLD prevalence (I2 = 99·9%) and NAFLD incidence ( I2 = 99·9%).

The study, “The prevalence and determinants of NAFLD and MAFLD and their severity in the VA primary care setting,” was published online in Clinical Gastroenterology and Hepatology.