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Metabolic dysfunction-associated fatty liver disease (MAFLD) - rather a bystander than a driver of mortality.

CONTEXT
Recently, the novel "metabolic dysfunction-associated fatty liver disease" (MAFLD) definition has been introduced.


OBJECTIVE
To assess the relevance of MAFLD for mortality.


DESIGN
Single-center cohort-study.


SETTING
Colorectal cancer screening program.


PATIENTS
4718 subjects aged 45-80 were grouped according to their BMI and the presence or absence of MAFLD.


MAIN OUTCOME MEASURES
Mortality was compared among these groups by performing a systematic read-out of the national health insurance system, fatty liver (FL) was diagnosed using ultrasound.


RESULTS
Overall prevalence of FL was 47.9%. 1200 (25.4%) were lean (BMI<25kg/m2) and did not have MAFLD, 73 (1.5%) patients were lean and had non-alcoholic fatty liver disease (NAFLD), but did not fulfill criteria for MAFLD, 221 (4.7%) were lean and fulfilled criteria for MAFLD. Additionally, 1043 (22.1%) and 925 (19.6%) subjects had MAFLD with overweight (BMI 25-30kg/m²) and obesity (BMI≥30kg/m²) while 1041 (22.1%) and 215 (4.6%) had overweight and obesity without FL.During a median follow-up of 7.5 (IQR: 4.0-9.6) years, 278 deaths (5.9%) occurred. Of these, 98 (2.1%) were cancer-related, 65 (1.4%) were cardiovascular, and 17 (0.4%) were liver-related. Overall survival was similar between patient strata (after 5 years: 93.9%-98.2%) with lean MAFLD having the numerically worst survival. Although lean and overweight patients with MAFLD had a numerically worse outcome compared to their non-MAFLD counterparts, this association was driven by age and metabolic comorbidities (predominantly diabetes) rather than the presence of MAFLD.


CONCLUSIONS
Presence of MAFLD does not increase mortality in a cohort of individuals aged 45-80 years.