Comparison of Clinical Characteristics and Outcomes of MAFLD and NAFLD in Chinese Health Examination Populations

Background and Aims: metabolic dysfunction-associated fatty liver disease (MAFLD) has remained controversial. We aimed to describe the fea-tures and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals. Meth-ods: In this retrospective cohort study, we enrolled 72,392 Chinese participants between 2014 and 2015. Participants were classified as MAFLD, nonalcoholic fatty liver disease (NAFLD), non-MAFLD-NAFLD, and a normal control group. The primary outcomes were liver-related and cardiovascular disease (CVD) events. Person-years of follow-up were cal-culated from enrolment to the diagnosis of the event, or the last date of data (June, 2020). Results: Of the 72,392 par-ticipants, 31.54% (22,835) and 28.33% (20,507) qualified the criteria for NAFLD or MAFLD, respectively. Compared with NAFLD, MAFLD patients were more likely to be male, over-weight, and have higher biochemical indices including liver enzyme levels. Lean MAFLD diagnosed with >_2 or >_3 meta-bolic abnormalities presented similar clinical manifestations. During the median follow-up of 5.22 years, 919 incident cases of severe liver disease and 2,073 CVD cases were re-corded. Compared with the normal control group, the NAFLD and MAFLD groups had a higher cumulative risk of liver fail-ure and cardiac-cerebral vascular diseases. There were no significant differences in risk between the non-MAFLD-NAFLD and normal group. Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular dis-eases, lean MAFLD came second, and obese-MAFLD had the lowest incidence. Conclusions: This real-world study pro-vided evidence for rationally assessing the benefit and prac-ticability of the change in terminology from NAFLD to MAFLD. MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.