Highlights
- •MAFLD was associated with higher risks of developing subclinical atherosclerosis.
- •MAFLD regression modified the risks of subclinical atherosclerosis.
- •The modified effects were more evident in those with low probability of fibrosis or less metabolic risk factors.
Abstract
Background
Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed and
diagnosed based on modified criteria. However, evidence for the risks of developing
subclinical atherosclerosis with MAFLD transitions according to its new definition
has never been reported.
Methods
Using data from a community-based cohort, 6232 participants aged 40 years or older
were included and were followed up for a median of 4.3 years during 2010–2015. Participants
were categorized into four groups (stable non-MAFLD, MAFLD regressed to non-MAFLD,
non-MAFLD progressed to MAFLD, and stable MAFLD). Subclinical atherosclerosis was
defined as elevated carotid intima-media thickness (CIMT), elevated brachial-ankle
pulse wave velocity (ba-PWV), or microalbuminuria.
Results
Compared with the stable non-MAFLD category, participants who progressed to MAFLD
at follow-up visit had a 1.356-fold increased risk of developing elevated CIMT [odds
ratio (OR) = 1.356; 95% confidence interval (CI) = 1.134–1.620], and a 1.458-fold
increased risk of incident microalbuminuria (OR = 1.458; 95% CI = 1.034–2.056) after
adjustment for confounders, respectively. In addition, participants with stable MAFLD
showed 17.6%, 32.4%, and 35.4% increased risks of developing elevated CIMT, elevated
ba-PWV and microalbuminuria, respectively. Compared with the stable MAFLD category,
participants with MAFLD and low probability of fibrosis at baseline who regressed
to non-MAFLD at follow-up visit had a 29.4% decreased risk of developing elevated
CIMT (OR = 0.706; 95% CI = 0.507–0.984), a 43.1% decreased risk of developing elevated
ba-PWV (OR = 0.569; 95% CI = 0.340–0.950), but was not significantly associated with
incident microalbuminuria (OR = 0.709; 95% CI = 0.386–1.301). The decreased risks
attributed to MAFLD regression were more evident in participants without diabetes
or dyslipidemia, as well as in those with 0–1 metabolic risk abnormalities, respectively.
Conclusions
MAFLD was significantly associated with higher risks of developing subclinical atherosclerosis.
Moreover, the regression of MAFLD might modify the risks of developing subclinical
atherosclerosis, especially among those with low probability of fibrosis or less metabolic
risk abnormalities. Since 40% of baseline participants with missing data on MAFLD
measurement at follow-up were excluded, the conclusions should be speculated with
caution.
Abbreviations:
ABI (ankle-brachial index), UACR (urinary albuminuria-to-creatinine ratio), ADA (American Diabetes Association), ALT (alanine aminotransferase), AST (aspartate aminotransferase), ba-PWV (brachial-ankle pulse wave velocity), BMI (body mass index), BP (blood pressure), CIMT (carotid intima-media thickness), CKD (chronic kidney disease), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), CVD (cardiovascular disease), DBP (diastolic blood pressure), DM (diabetes mellitus), eGFR (estimated glomerular filtration rate), FIB-4 index (Fibrosis-4 index), FPG (fasting plasma glucose), HbA1c (glycated hemoglobin), HDL-c (high-density lipoprotein cholesterol), HOMA-IR (homeostasis model assessment of insulin resistance), LDL-c (low-density lipoprotein cholesterol), MAFLD (metabolic dysfunction-associated fatty liver disease), NAFLD (nonalcoholic fatty liver disease), SBP (systolic blood pressure), TC (total cholesterol), TG (triglycerides), WC (waist circumference)Keywords
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Article info
Publication history
Published online: April 22, 2021
Accepted:
April 18,
2021
Received:
February 4,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
