MAFLD might be better in identifying subjects with sarcopenia or cardiovascular risk than NAFLD: A nationwide study

Abstract Background and Aim Clinical features of non‐alcoholic fatty liver disease (NAFLD), but not fulfilling the diagnostic criteria of metabolic dysfunction‐associated fatty liver disease (MAFLD), remain unclear. We investigated the risk of sarcopenia and cardiovascular disease (CVD) in MAFLD and non‐metabolic risk (MR) NAFLD. Methods Subjects were selected from the Korean National Health and Nutrition Examination Surveys 2008–2011. Liver steatosis was assessed using fatty liver index. Significant liver fibrosis was defined using fibrosis‐4 index, categorized by age cut‐offs. Sarcopenia was defined as the lowest quintile sarcopenia index. Atherosclerotic CVD (ASCVD) risk score > 10% was defined as high probability. Results A total of 7248 subjects had fatty liver (137 with non‐MR NAFLD, 1752 with MAFLD/non‐NAFLD, and 5359 with overlapping MAFLD and NAFLD). In non‐MR NAFLD group 28 (20.4%) had significant fibrosis. The risk of sarcopenia (adjusted odds ratio [aOR] = 2.71, 95% confidence index [CI] = 1.27–5.78) and high probability of ASCVD (aOR = 2.79, 95% CI = 1.23–6.35) was significantly higher in MAFLD/non‐NAFLD group than in non‐MR NAFLD group (all P < 0.05). The risk of sarcopenia and high probability of ASCVD was similar between subjects with and without significant fibrosis in non‐MR NAFLD group (all P > 0.05). However, the risk was significantly higher in MAFLD group than in non‐MR NAFLD group (aOR = 3.38 for sarcopenia and 3.73 for ASCVD; all P < 0.05). Conclusions The risks of sarcopenia and CVD were significantly higher in MAFLD group but did not differ according to fibrotic burden in non‐MR NAFLD group. The MAFLD criteria might be better for identifying high‐risk fatty liver disease than the NAFLD criteria.