Cardiovascular and Renal Burdens of Metabolic Associated Fatty Liver Disease from Serial US National Surveys, 1999–2016
Metabolic associated fatty liver disease (MAFLD) has emerged as a significant public health concern, with its prevalence and associated cardiovascular and renal burdens increasing over the past two decades. This study, utilizing data from the US National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2016, provides a comprehensive analysis of the trends and burdens of MAFLD and its comparison with non-alcoholic fatty liver disease (NAFLD).
MAFLD is defined by the presence of hepatic steatosis accompanied by one of three criteria: general overweight/obesity, type 2 diabetes mellitus (T2DM), or evidence of metabolic dysregulation. The study analyzed data from 19,617 non-pregnant adults aged 20 years and older, examining the prevalence of MAFLD, its associated cardiovascular and renal risks, and the trends over time.
The prevalence of MAFLD increased significantly from 28.4% in 1999–2002 to 35.8% in 2011–2016. By the latter period, nearly half of the adults with MAFLD had hypertension (49.0%), over half had dyslipidemia (57.8%), and a quarter had diabetes mellitus (26.4%). Additionally, 88.7% had central obesity, and 18.5% were current smokers. The 10-year cardiovascular risk ranged from 10.5% to 13.1%, and 19.7% had chronic kidney disease (CKD).
The study found that adults with MAFLD showed an increase in obesity and an increase in treatment to lower blood pressure, lipids, and hemoglobin A1c (HbA1c). However, there was no significant improvement in glycemic control among diabetic patients. The 10-year cardiovascular risk decreased over time, but there was no change in the prevalence of CKD, myocardial infarction, or stroke.
Compared to NAFLD, MAFLD had a significantly higher prevalence and was associated with a greater absolute cardiorenal burden. The study highlights the need for early identification and risk stratification of MAFLD and emphasizes the importance of collaboration between endocrinologists and hepatologists in managing this condition.
The findings underscore the growing burden of MAFLD and its associated cardiovascular and renal risks. The study calls for increased awareness among healthcare providers and the implementation of early intervention strategies to mitigate the long-term effects of MAFLD.
The data from the NHANES surveys provide a robust basis for understanding the trends and burdens of MAFLD. The study’s use of the ultrasound-fatty liver index (US-FLI) to define hepatic steatosis adds to the validity of the findings. The comprehensive analysis of cardiovascular and renal markers offers valuable insights into the health implications of MAFLD.
In conclusion, the study demonstrates the increasing prevalence of MAFLD and its significant cardiovascular and renal burdens. The findings highlight the need for early detection and management of MAFLD to prevent its associated complications. The study also suggests that the absolute cardiorenal burden may be greater for MAFLD than for NAFLD, calling for a reevaluation of current diagnostic and management strategies.
The study’s implications extend beyond the clinical setting, emphasizing the need for public health initiatives to address the growing burden of MAFLD. The findings also call for further research into the pathophysiology of MAFLD and the development of targeted therapies to reduce its associated risks.
Overall, this study provides a comprehensive analysis of the cardiovascular and renal burdens of MAFLD, offering valuable insights for healthcare providers, researchers, and policymakers. The findings underscore the importance of early intervention and the need for a multidisciplinary approach to managing MAFLD.
doi.org/10.1097/CM9.0000000000001513
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