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Xiao P, Liang P, Gao P, Wu J. Sex- and region-specific associations of skeletal muscle mass with metabolic dysfunction-associated fatty liver disease. Front Endocrinol (Lausanne) 2022; 13:1057261. [PMID: 36531457 PMCID: PMC9755203 DOI: 10.3389/fendo.2022.1057261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Metabolic dysfunction-associated fatty liver disease (MAFLD) is known to be the most common chronic liver disease worldwide, and accumulating evidence suggests that skeletal muscle might play an important role in metabolic health. However, the association between skeletal muscle and MAFLD is poorly understood so far. Therefore, we aimed to evaluate the associations of skeletal muscle with MAFLD and significant fibrosis. METHODS A cross-sectional analysis was conducted using data obtained from the 2017-2018 US National Health and Nutrition Examination Survey. The whole-body, appendicular, and trunk skeletal muscle mass index (SMI) were assessed by dual-energy x-ray absorptiometry. MAFLD and significant fibrosis were assessed by transient elastography. Survey-weight adjusted multivariable logistic regressions were used to determine the associations. The area under the receiver operating characteristic curve (AUC) and variable importance scores from the random forest and logistic regression model were calculated to assess the predictive capability of variables and models. RESULTS Of the 2065 participants, those with appendicular SMI in the highest quartile were associated with a lower risk for MAFLD in both sexes (male, OR[95%CI]: 0.46 [0.25~0.84]; female, OR[95%CI]: 0.32 [0.13~0.82]), but with a significantly different scale of the associations between sexes (P interaction = 0.037). However, females with trunk SMI in the highest quartile had an increased risk of significant fibrosis (OR[95%CI]: 7.82 [1.86~32.77]). Trunk SMI and appendicular SMI ranked the third contributor to MAFLD in random forest and logistic regression models, respectively. Taking appendicular and trunk SMI into consideration, the AUCs for MAFLD were 0.890 and 0.866 in random forest and logistic regression models, respectively. DISCUSSION The distribution of skeletal muscle mass differently affects MAFLD and significant fibrosis in the sex groups. Higher appendicular skeletal muscle mass was associated with a lower risk of MAFLD, while the risk of significant fibrosis in females was increased with the trunk skeletal muscle mass.
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Affiliation(s)
- Pei Xiao
- Center for Non-Communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Pu Liang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Pu Liang,
| | - Panjun Gao
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jinyi Wu
- Department of Public Health, Wuhan Fourth Hospital, Wuhan, China
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Kim J, Lee M, Kim SY, Kim JH, Nam JS, Chun SW, Park SE, Kim KJ, Lee YH, Nam JY, Kang ES. Non-Laboratory-Based Simple Screening Model for Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Developed Using Multi-Center Cohorts. Endocrinol Metab (Seoul) 2021; 36:823-834. [PMID: 34474517 PMCID: PMC8419619 DOI: 10.3803/enm.2021.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most prevalent cause of chronic liver disease worldwide. Type 2 diabetes mellitus (T2DM) is a risk factor that accelerates NAFLD progression, leading to fibrosis and cirrhosis. Thus, here we aimed to develop a simple model to predict the presence of NAFLD based on clinical parameters of patients with T2DM. METHODS A total of 698 patients with T2DM who visited five medical centers were included. NAFLD was evaluated using transient elastography. Univariate logistic regression analyses were performed to identify potential contributors to NAFLD, followed by multivariable logistic regression analyses to create the final prediction model for NAFLD. RESULTS Two NAFLD prediction models were developed, with and without serum biomarker use. The non-laboratory model comprised six variables: age, sex, waist circumference, body mass index (BMI), dyslipidemia, and smoking status. For a cutoff value of ≥60, the prediction accuracy was 0.780 (95% confidence interval [CI], 0.743 to 0.817). The second comprehensive model showed an improved discrimination ability of up to 0.815 (95% CI, 0.782 to 0.847) and comprised seven variables: age, sex, waist circumference, BMI, glycated hemoglobin, triglyceride, and alanine aminotransferase to aspartate aminotransferase ratio. Our non-laboratory model showed non-inferiority in the prediction of NAFLD versus previously established models, including serum parameters. CONCLUSION The new models are simple and user-friendly screening methods that can identify individuals with T2DM who are at high-risk for NAFLD. Additional studies are warranted to validate these new models as useful predictive tools for NAFLD in clinical practice.
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Affiliation(s)
- Jiwon Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Minyoung Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Soo Yeon Kim
- Department of Education and Training, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Ji-Hye Kim
- Severance Health Check-up, Severance Hospital, Yonsei University Health System, Seoul,
Korea
| | - Ji Sun Nam
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Sung Wan Chun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan,
Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Kwang Joon Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Yong-ho Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Joo Young Nam
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
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Méndez-Sánchez N, Díaz-Orozco LE. Editorial: International Consensus Recommendations to Replace the Terminology of Non-Alcoholic Fatty Liver Disease (NAFLD) with Metabolic-Associated Fatty Liver Disease (MAFLD). Med Sci Monit 2021; 27:e933860. [PMID: 34248137 PMCID: PMC8284081 DOI: 10.12659/msm.933860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 12/14/2022] Open
Abstract
In 2020, international consensus guidelines recommended the renaming of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD), supported by diagnostic criteria. MAFLD affects up to 25% of the global population. However, the rates of MAFLD are likely to be underestimated due to the increasing prevalence of type 2 diabetes mellitus (T2DM) and obesity. Within the next decade, MAFLD has been projected to become a major cause of cirrhosis and hepatocellular carcinoma (HCC) worldwide, as well as the most common indication for liver transplantation in the US. This transition in terminology and clinical criteria may increase momentum and clinical evidence at multiple levels, including patient diagnosis, management, and care, and provide the basis for new research areas and clinical development for therapeutics. The diagnostic criteria for MAFLD are practical, simple, and superior to the existing NAFLD criteria for identifying patients at increased risk of developing progressive liver disease. This Editorial aims to present the historical evolution of the terminology for fatty liver disease and the advantages of diagnosis, patient management, and future research on MAFLD.
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Affiliation(s)
- Nahum Méndez-Sánchez
- Liver Research Unit, Médica Sur Clinic and Foundation and Faculty of Medicine, Mexico City, Mexico
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Luis Enrique Díaz-Orozco
- Liver Research Unit, Médica Sur Clinic and Foundation and Faculty of Medicine, Mexico City, Mexico
- National Autonomous University of Mexico, Mexico City, Mexico
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Lim S, Kim JW, Targher G. Links between metabolic syndrome and metabolic dysfunction-associated fatty liver disease. Trends Endocrinol Metab 2021; 32:500-514. [PMID: 33975804 DOI: 10.1016/j.tem.2021.04.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023]
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a chronic condition characterized by hepatic fat accumulation combined with underlying metabolic dysregulation. Having evolved from the previous term of nonalcoholic fatty liver disease (NAFLD), the term MAFLD more closely implicates the presence of overweight/obesity, type 2 diabetes, or metabolic dysregulation as essential pathogenic factors, leading to better identification of individuals with this metabolic liver disease. Low-grade inflammation, increased oxidative stress, mitochondrial dysfunction, and intestinal dysbiosis are also involved in its pathogenesis. MAFLD is not only associated with liver-related complications, but also with adverse cardiometabolic outcomes. Further studies are needed to assess whether the newly proposed definition of MAFLD is more accurate than the NAFLD in predicting the adverse liver-related and extrahepatic outcomes.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
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Cardiovascular and renal burdens of metabolic associated fatty liver disease from serial US national surveys, 1999-2016. Chin Med J (Engl) 2021; 134:1593-1601. [PMID: 34091530 PMCID: PMC8280082 DOI: 10.1097/cm9.0000000000001513] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Non-communicable chronic diseases have become the leading causes of disease burden worldwide. The trends and burden of “metabolic associated fatty liver disease” (MAFLD) are unknown. We aimed to investigate the cardiovascular and renal burdens in adults with MAFLD and non-alcoholic fatty liver disease (NAFLD). Methods: Nationally representative data were analyzed including data from 19,617 non-pregnant adults aged ≥20 years from the cross-sectional US National Health and Nutrition Examination Survey periods, 1999 to 2002, 2003 to 2006, 2007 to 2010, and 2011 to 2016. MAFLD was defined by the presence of hepatic steatosis plus general overweight/obesity, type 2 diabetes mellitus, or evidence of metabolic dysregulation. Results: The prevalence of MAFLD increased from 28.4% (95% confidence interval 26.3–30.6) in 1999 to 2002 to 35.8% (33.8–37.9) in 2011 to 2016. In 2011 to 2016, among adults with MAFLD, 49.0% (45.8–52.2) had hypertension, 57.8% (55.2–60.4) had dyslipidemia, 26.4% (23.9–28.9) had diabetes mellitus, 88.7% (87.0–80.1) had central obesity, and 18.5% (16.3–20.8) were current smokers. The 10-year cardiovascular risk ranged from 10.5% to 13.1%; 19.7% (17.6–21.9) had chronic kidney diseases (CKDs). Through the four periods, adults with MAFLD showed an increase in obesity; increase in treatment to lower blood pressure (BP), lipids, and hemoglobin A1c; and increase in goal achievements for BP and lipids but not in goal achievement for glycemic control in diabetes mellitus. Patients showed a decreasing 10-year cardiovascular risk over time but no change in the prevalence of CKDs, myocardial infarction, or stroke. Generally, although participants with NAFLD and those with MAFLD had a comparable prevalence of cardiovascular disease and CKD, the prevalence of MAFLD was significantly higher than that of NAFLD. Conclusions: From 1999 to 2016, cardiovascular and renal risks and diseases have become highly prevalent in adults with MAFLD. The absolute cardiorenal burden may be greater for MAFLD than for NAFLD. These data call for early identification and risk stratification of MAFLD and close collaboration between endocrinologists and hepatologists.
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Vasques-Monteiro IML, Souza-Mello V. Coronavirus disease 2019 severity in obesity: Metabolic dysfunction-associated fatty liver disease in the spotlight. World J Gastroenterol 2021; 27:1738-1750. [PMID: 33967554 PMCID: PMC8072197 DOI: 10.3748/wjg.v27.i16.1738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has drawn the scientific community's attention to pre-existing metabolic conditions that could aggravate the infection, causing extended viral shedding, prolonged hospitalization, and high death rates. Metabolic dysfunction-associated fatty liver disease (MAFLD) emerges as a surrogate for COVID-19 severity due to the constellation of metabolic alterations it entails. This review outlines the impact MAFLD exerts on COVID-19 severity in obese subjects, besides the possible mechanistic links to the poor outcomes. The data collected showed that MAFLD patients had poorer COVID-19 outcomes than non-MAFLD obese subjects. MAFLD is generally accompanied by impaired glycemic control and systemic arterial hypertension, both of which can decompensate during the COVID-19 clinical course. Also, MAFLD subjects had higher plasma inflammatory marker concentrations than non-MAFLD subjects, which might be related to an intensified cytokine storm syndrome frequently associated with the need for mechanical ventilation and death. In conclusion, MAFLD represents a higher risk than obesity for COVID-19 severity, resulting in poor outcomes and even progression to non-alcoholic steatohepatitis. Hepatologists should include MAFLD subjects in the high-risk group, intensify preventive measurements, and prioritize their vaccination.
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Affiliation(s)
- Isabela Macedo Lopes Vasques-Monteiro
- Anatomy, Rio de Janeiro State University, Rio de Janeiro 20551030, Brazil
- Food Science and Technology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290250, Brazil
| | - Vanessa Souza-Mello
- Anatomy, Rio de Janeiro State University, Rio de Janeiro 20551030, Brazil
- Laboratory of Morphometry, Metabolism, and Cardiovascular Diseases, Biomedical Center, Institute of Biology, Anatomy Department, Rio de Janeiro State University, Rio de Janeiro 20551030, Brazil
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