Proportion and Clinical Characteristics of Metabolic-Associated Fatty Liver Disease and Associated Liver Fibrosis in an Urban Chinese Population
Authors: Mengmeng Hou1, Qi Gu2, Jiawei Cui1, Yao Dou1, Xiuhong Huang3, Jie Li2, Liang Qiao4, Yuemin Nan1
Affiliations:
1Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China;
2Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210008, China;
3Healthy Physical Examination Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China;
4Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, NSW 2145, Australia.
Introduction
Metabolic-associated fatty liver disease (MAFLD) has emerged as the most prevalent form of chronic liver disease globally, affecting nearly one-third of the world’s population. Unlike its predecessor, non-alcoholic fatty liver disease (NAFLD), MAFLD emphasizes metabolic dysfunction regardless of alcohol consumption or other liver diseases. This redefinition allows for the identification of patients at higher risk of disease progression, including hepatic fibrosis, cirrhosis, and hepatocellular carcinoma.
Liver fibrosis is a critical prognostic factor in MAFLD, as it significantly increases the risk of liver-related morbidity and mortality. Despite its importance, the prevalence and risk factors for MAFLD and associated fibrosis in the general Chinese population remain poorly characterized. This study aimed to address this gap by investigating the proportion and clinical characteristics of MAFLD and liver fibrosis in an urban Chinese population, as well as identifying risk factors for significant fibrosis.
Methods
Study Population
This cross-sectional study enrolled 22,970 participants who underwent routine health examinations at The Third Hospital of Hebei Medical University between May 2019 and March 2023. Exclusion criteria included inadequate data for MAFLD classification, duplicate records, and pregnancy. Ethical approval was obtained, and informed consent was secured from all participants.
Diagnosis and Classification of MAFLD
MAFLD was diagnosed based on the presence of hepatic steatosis on ultrasonography and one of the following criteria: body mass index (BMI) ≥23.00 kg/m², type 2 diabetes mellitus (T2DM), or metabolic dysregulation (MD). MD was defined as having at least two of the following: waist circumference ≥90 cm (men) or ≥80 cm (women), blood pressure ≥130/85 mmHg, triglycerides ≥1.70 mmol/L, high-density lipoprotein cholesterol <1.0 mmol/L (men) or <1.3 mmol/L (women), or fasting plasma glucose 5.6–6.9 mmol/L.
Participants were categorized into subgroups based on BMI and metabolic abnormalities: overweight (OW) and lean groups, with further subdivisions considering the presence of MD and T2DM.
Clinical and Laboratory Parameters
Demographic, anthropometric, and laboratory data were collected, including age, sex, BMI, blood pressure, lipid profiles, glucose levels, and liver function tests. Liver fibrosis was assessed using the Fibrosis-4 (FIB-4) index, with a score ≥1.3 indicating significant fibrosis.
Statistical Analysis
Data were analyzed using Stata software. Continuous variables were expressed as means or medians, and categorical variables as percentages. Univariate and multivariate logistic regression analyses were performed to identify risk factors for MAFLD and significant fibrosis.
Results
Proportion of MAFLD
The overall proportion of MAFLD in the study population was 28.77% (6,608/22,970). Males had a significantly higher proportion than females (42.26% vs. 19.15%, p < 0.001). The proportion increased with age, peaking at 60–69 years (38.31%) before declining.
Clinical Characteristics of MAFLD
Compared to non-MAFLD individuals, MAFLD patients were older, more likely to be male, and had higher BMI, blood pressure, lipid levels, and glucose levels. Liver and kidney function markers were also worse in MAFLD patients.
Proportion of Significant Fibrosis
Significant fibrosis was observed in 16.87% (1,115/6,608) of MAFLD patients. Females had a higher proportion than males (20.87% vs. 14.33%, p < 0.001), and the proportion increased significantly with age. Lean MAFLD patients had a higher proportion of significant fibrosis than overweight patients (22.77% vs. 16.19%, p < 0.001).
Risk Factors for Significant Fibrosis
Multivariate analysis identified several independent risk factors for significant fibrosis: male sex (OR = 0.676), hepatitis B surface antigen (HBsAg) positivity (OR = 2.611), BMI ≥23.00 kg/m² (OR = 0.632), blood pressure ≥130/85 mmHg (OR = 1.885), and plasma glucose ≥5.6 mmol/L (OR = 1.815).
Discussion
This study provides a comprehensive assessment of MAFLD and associated liver fibrosis in an urban Chinese population. The observed MAFLD proportion of 28.77% aligns with global estimates, highlighting the significant burden of this condition. The higher proportion in males and older individuals underscores the role of sex hormones and age-related metabolic changes in disease progression.
The finding that 16.87% of MAFLD patients had significant fibrosis emphasizes the importance of early screening and intervention. The higher proportion of fibrosis in lean MAFLD patients challenges the traditional association of liver disease with obesity and suggests that metabolic dysregulation, rather than BMI alone, drives disease progression.
Risk factors such as hypertension, diabetes, and HBsAg positivity highlight the complex interplay between metabolic and viral factors in liver fibrosis. These findings underscore the need for integrated management strategies that address both metabolic and viral components of liver disease.
Conclusion
MAFLD is highly prevalent in urban China, with significant variations across age and sex groups. The high proportion of significant fibrosis, particularly in lean individuals and those with metabolic comorbidities, underscores the need for targeted screening and intervention. Early identification and management of risk factors, including hypertension, diabetes, and viral hepatitis, are critical to reducing the burden of MAFLD and its complications.
DOI: doi.org/10.1097/CM9.0000000000003141
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