Prevalence of Metabolic Associated Fatty Liver Disease Increasing in US Adults

Theodore C. Friedman, MD, PhD

Credit: LinkedIn

The rate of metabolic-associated fatty liver disease (MAFLD), the leading cause of liver disease, is increasing in adults in the United States, according to new research presented at ENDO 2023.¹

The findings suggested the Mexican American population persistently experienced the highest percentage of MAFLD, particularly in 2018, but the prevalence of increase was higher among the White population.

“MAFLD affects Hispanics at a higher prevalence relative to Blacks and Whites,” Theodore C. Friedman, MD, PhD, chair of the department of internal medicine at Charles R. Drew University of Medicine & Science, said in a statement.¹ “Overall, the increase in MAFLD is concerning, as this condition can lead to liver failure and cardiovascular diseases and has an important health disparity.”

MAFLD was previously known as non-alcoholic fatty liver disease (NAFLD) and is fast becoming the most common indication for liver transplantation. Literature suggests the term may better describe the liver disease associated with known metabolic dysfunction.² The new definition of MAFLD refers to hepatic steatosis in addition to one of the following 3 criteria: overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation.

Exclusions of other liver diseases including alcoholic, autoimmune, or vital hepatitis are not a prerequisite for the diagnosis of MAFLD. When left untreated, MAFLD can lead to liver cancer and liver failure. Research shows within the general population, the overall global prevalence of MAFLD is estimated to be 25%. Due to common risk factors, cardiac-related death is one of the leading causes of death in MAFLD patients.

In the current analysis, the investigative team analyzed data for 32,726 participants from the National Health and Nutrition Examination Survey (NHANES) from 1988 - 2018. Overall, both MAFLD and obesity increased with time and the increase in MAFLD was greater than the increase in obesity, according to the study’s first author Magda Shaheen, MD, PhD, MPH, of Charles R. Drew University of Medicine & Science.

Data showed the percentage of people with MAFLD increased from 16% in 1988 to 37% in 2018 (a 131% increase). On the other hand, the percentage of obesity rose from 23% in 1988 to 40% in 2018 (a 74% increase). The team noted that the prevalence of MAFLD increased faster than the prevalence of obesity, suggesting that the observed increase in risk factors, such as diabetes and hypertension, may additionally contribute to the increase in the prevalence of MAFLD.

By race and ethnicity, the percentage of MAFLD was higher at all times compared to the overall population among Mexican American patients. The analysis showed the percentage increase of MAFLD in 2018 relative to 1988 was 133% among the White population, 61% among Mexican American patients, and 56% among the Black population.

“In summary, MAFLD is increasing with time and more efforts are needed to control this epidemic,” Shaheen said.

References

1. Prevalence of metabolic associated fatty liver disease is increasing. Newswise. June 16, 2023. Accessed June 16, 2023. https://www.newswise.com/articles/prevalence-of-metabolic-associated-fatty-liver-disease-is-increasing.
2. Sangro, P., de la Torre Aláez, M., Sangro, B. et al. Metabolic dysfunction–associated fatty liver disease (MAFLD): an update of the recent advances in pharmacological treatment. J Physiol Biochem (2023). https://doi.org/10.1007/s13105-023-00954-4