“Outcomes of NAFLD and MAFLD: Results From a Community-Based, Prospective Cohort Study”

Background: The term “metabolic (dysfunction)-associated fatty liver disease” (MAFLD) is suggested alternative for “non-alcoholic fatty liver disease” (NAFLD), as it better reflects metabolic dysfunction. No study has compared outcomes of the two diagnostic criteria. Methods: In an ongoing, community-based, cohort-study in suburban Sri Lanka, participants were randomly selected in 2007. They were reassessed in 2014 to evaluate new-onset metabolic traits (MTs) and cardiovascular-events (CVEs). Baseline characteristics, MTs and CVEs after 7-years were compared in NAFLD and MAFLD and vs. controls. Similarly, we compared these parameters in those excluded by the NAFLD definition but captured by the MAFLD definition and vice versa, and vs. controls. Findings: Of 2985 recruited in 2007, 940(31.5%) had NAFLD, 990(33.1%) had MAFLD and 362(12.1%) were controls. When compared to NAFLD, MAFLD captured an additional 2.9% and lost 1.3% individuals. At baseline, anthropometric and metabolic traits were similar in NAFLD and MAFLD. At follow-up in 7-years, the odds of having new-onset MTs and fatal/non-fatal CVEs were similar in the groups, but were significantly higher compared to controls. Those excluded by the NAFLD definition but captured by the MAFLD definition showed higher baseline MTs compared to those excluded by the MAFLD definition but captured by the NAFLD definition, and had higher odds for having new-onset MTs and CVEs compared to controls. Interpretation: Although NAFLD and MAFLD had similar MTs at baseline, and similar outcomes after 7-years, those who were excluded by the NAFLD definition but captured by the MAFLD definition seem at higher risk of adverse outcomes than those excluded by the MAFLD definition but captured by the NAFLD definition. Although the increase the index population was small, redefining NAFLD as MAFLD seemed to improve clinical utility. Funding Statement: Grants from the Ministry of Higher Education of Sri Lanka and National Center for Global Health and Medicine, Tokyo, Japan. Declaration of Interests: None. Ethics Approval Statement: Ethical approval for the study was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya. Informed written consent was obtained from all participants in the RHS at baseline and at follow up. Verbal and implied consent was obtained from respondents who did not attend follow up in 2014 but were traced later.