Metabolic dysfunction–associated fatty liver disease improves detection of high liver stiffness: The Rotterdam Study

Laurens A. van Kleef; Ibrahim Ayada; Louise J.M. Alferink; Qiuwei Pan; Robert J. de Knegt

doi:10.1002/hep.32131

Metabolic dysfunction–associated fatty liver disease improves detection of high liver stiffness: The Rotterdam Study

Laurens A. van Kleef^*, Ibrahim Ayada, Louise J.M. Alferink, Qiuwei Pan, Robert J. de Knegt

^*Corresponding author for this work

Gastroenterology & Hepatology

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background and Aims: Recently metabolic dysfunction–associated fatty liver disease (MAFLD) has been introduced and was defined as hepatic steatosis with either overweight, diabetes, and/or a combination of other metabolic risk factors. We investigated the application of the MAFLD criteria as compared with NAFLD. Approach and Results: We performed a cross-sectional analysis within the Rotterdam Study, a large prospective population-based cohort. Participants who attended the liver ultrasound and transient elastography program between 2009 and 2014 were eligible for inclusion. Subsequently, individuals with viral hepatitis, alcohol intake >60 g/day, missing alcohol data, and/or missing body mass index were excluded. According to their NAFLD and MAFLD status based on metadata and ultrasound, participants were allocated in overlap fatty liver disease (FLD), NAFLD-only, MAFLD-only, or no FLD. Fibrosis was defined as liver stiffness ≥8.0 kPa. In our analysis, 5445 participants were included: 1866 (34.3%) had MAFLD and 1604 (29.5%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1623 (29.8%)”] had NAFLD. This resulted in 1547 (28.4%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1566 (28.8%)”] individuals with overlap FLD, 319 (5.9%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “300 (5.5%)”] with MAFLD-only, 57 (1.0%) with NAFLD-only, and 3522 (64.7%) with no FLD. The MAFLD-only group was strongly associated with fibrosis (adjusted OR 5.30 [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from "OR 5.27"], p < 0.001) and log-transformed liver stiffness (adjusted beta 0.116, p < 0.001), as opposed to the NAFLD-only group, in which no cases of fibrosis were identified and no association with liver stiffness (adjusted beta 0.006, p = 0.90) was found. Conclusions: FLD is highly prevalent in the general population. However, not the NAFLD-only, but the MAFLD-only group was associated with fibrosis and higher liver stiffness—independent of demographic and lifestyle factors. We believe that using the MAFLD criteria will help improve the identification and treatment of patients with FLD at risk for fibrosis.

Original language	English
Pages (from-to)	419-429
Number of pages	11
Journal	Hepatology
Volume	75
Issue number	2
Early online date	27 Aug 2021
DOIs	https://doi.org/10.1002/hep.32131
Publication status	Published - Feb 2022

Bibliographical note

Funding Information:
Dr. de Knegt consults and received grants from AbbVie. He is on the speakers’ bureau for Echosens. He received grants from Gilead and Janssen.

Funding Information:
Erasmus Medical Center and Erasmus University (Rotterdam, Netherlands); Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); the Municipality of Rotterdam; and the Foundation for Liver and Gastrointestinal Research

Funding Information:
The authors gratefully acknowledge the contribution of the participants of the Rotterdam Study, research assistants (particularly Paulien van Wijngaarden for performing the liver ultrasounds), the general practitioners, hospitals, and pharmacies in Rotterdam. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University (Rotterdam, Netherlands), Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. Financial support was also provided by the Foundation for Liver and Gastrointestinal Research (Rotterdam, the Netherlands). The funding sources did not influence study design, data collection, analysis and interpretation of the data, nor the writing of the report and decision to submit for publication.

Publisher Copyright:
© 2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases

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Cite this

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title = "Metabolic dysfunction–associated fatty liver disease improves detection of high liver stiffness: The Rotterdam Study",

abstract = "Background and Aims: Recently metabolic dysfunction–associated fatty liver disease (MAFLD) has been introduced and was defined as hepatic steatosis with either overweight, diabetes, and/or a combination of other metabolic risk factors. We investigated the application of the MAFLD criteria as compared with NAFLD. Approach and Results: We performed a cross-sectional analysis within the Rotterdam Study, a large prospective population-based cohort. Participants who attended the liver ultrasound and transient elastography program between 2009 and 2014 were eligible for inclusion. Subsequently, individuals with viral hepatitis, alcohol intake >60 g/day, missing alcohol data, and/or missing body mass index were excluded. According to their NAFLD and MAFLD status based on metadata and ultrasound, participants were allocated in overlap fatty liver disease (FLD), NAFLD-only, MAFLD-only, or no FLD. Fibrosis was defined as liver stiffness ≥8.0 kPa. In our analysis, 5445 participants were included: 1866 (34.3%) had MAFLD and 1604 (29.5%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1623 (29.8%)”] had NAFLD. This resulted in 1547 (28.4%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1566 (28.8%)”] individuals with overlap FLD, 319 (5.9%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “300 (5.5%)”] with MAFLD-only, 57 (1.0%) with NAFLD-only, and 3522 (64.7%) with no FLD. The MAFLD-only group was strongly associated with fibrosis (adjusted OR 5.30 [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from {"}OR 5.27{"}], p < 0.001) and log-transformed liver stiffness (adjusted beta 0.116, p < 0.001), as opposed to the NAFLD-only group, in which no cases of fibrosis were identified and no association with liver stiffness (adjusted beta 0.006, p = 0.90) was found. Conclusions: FLD is highly prevalent in the general population. However, not the NAFLD-only, but the MAFLD-only group was associated with fibrosis and higher liver stiffness—independent of demographic and lifestyle factors. We believe that using the MAFLD criteria will help improve the identification and treatment of patients with FLD at risk for fibrosis.",

author = "{van Kleef}, {Laurens A.} and Ibrahim Ayada and Alferink, {Louise J.M.} and Qiuwei Pan and {de Knegt}, {Robert J.}",

note = "Funding Information: Dr. de Knegt consults and received grants from AbbVie. He is on the speakers{\textquoteright} bureau for Echosens. He received grants from Gilead and Janssen. Funding Information: Erasmus Medical Center and Erasmus University (Rotterdam, Netherlands); Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); the Municipality of Rotterdam; and the Foundation for Liver and Gastrointestinal Research Funding Information: The authors gratefully acknowledge the contribution of the participants of the Rotterdam Study, research assistants (particularly Paulien van Wijngaarden for performing the liver ultrasounds), the general practitioners, hospitals, and pharmacies in Rotterdam. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University (Rotterdam, Netherlands), Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. Financial support was also provided by the Foundation for Liver and Gastrointestinal Research (Rotterdam, the Netherlands). The funding sources did not influence study design, data collection, analysis and interpretation of the data, nor the writing of the report and decision to submit for publication. Publisher Copyright: {\textcopyright} 2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases",

year = "2022",

month = feb,

doi = "10.1002/hep.32131",

language = "English",

volume = "75",

pages = "419--429",

journal = "Hepatology",

issn = "0270-9139",

publisher = "Lippincott Williams & Wilkins",

number = "2",

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TY - JOUR

T1 - Metabolic dysfunction–associated fatty liver disease improves detection of high liver stiffness

T2 - The Rotterdam Study

AU - van Kleef, Laurens A.

AU - Ayada, Ibrahim

AU - Alferink, Louise J.M.

AU - Pan, Qiuwei

AU - de Knegt, Robert J.

N1 - Funding Information: Dr. de Knegt consults and received grants from AbbVie. He is on the speakers’ bureau for Echosens. He received grants from Gilead and Janssen. Funding Information: Erasmus Medical Center and Erasmus University (Rotterdam, Netherlands); Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); the Municipality of Rotterdam; and the Foundation for Liver and Gastrointestinal Research Funding Information: The authors gratefully acknowledge the contribution of the participants of the Rotterdam Study, research assistants (particularly Paulien van Wijngaarden for performing the liver ultrasounds), the general practitioners, hospitals, and pharmacies in Rotterdam. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University (Rotterdam, Netherlands), Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. Financial support was also provided by the Foundation for Liver and Gastrointestinal Research (Rotterdam, the Netherlands). The funding sources did not influence study design, data collection, analysis and interpretation of the data, nor the writing of the report and decision to submit for publication. Publisher Copyright: © 2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases

PY - 2022/2

Y1 - 2022/2

N2 - Background and Aims: Recently metabolic dysfunction–associated fatty liver disease (MAFLD) has been introduced and was defined as hepatic steatosis with either overweight, diabetes, and/or a combination of other metabolic risk factors. We investigated the application of the MAFLD criteria as compared with NAFLD. Approach and Results: We performed a cross-sectional analysis within the Rotterdam Study, a large prospective population-based cohort. Participants who attended the liver ultrasound and transient elastography program between 2009 and 2014 were eligible for inclusion. Subsequently, individuals with viral hepatitis, alcohol intake >60 g/day, missing alcohol data, and/or missing body mass index were excluded. According to their NAFLD and MAFLD status based on metadata and ultrasound, participants were allocated in overlap fatty liver disease (FLD), NAFLD-only, MAFLD-only, or no FLD. Fibrosis was defined as liver stiffness ≥8.0 kPa. In our analysis, 5445 participants were included: 1866 (34.3%) had MAFLD and 1604 (29.5%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1623 (29.8%)”] had NAFLD. This resulted in 1547 (28.4%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1566 (28.8%)”] individuals with overlap FLD, 319 (5.9%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “300 (5.5%)”] with MAFLD-only, 57 (1.0%) with NAFLD-only, and 3522 (64.7%) with no FLD. The MAFLD-only group was strongly associated with fibrosis (adjusted OR 5.30 [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from "OR 5.27"], p < 0.001) and log-transformed liver stiffness (adjusted beta 0.116, p < 0.001), as opposed to the NAFLD-only group, in which no cases of fibrosis were identified and no association with liver stiffness (adjusted beta 0.006, p = 0.90) was found. Conclusions: FLD is highly prevalent in the general population. However, not the NAFLD-only, but the MAFLD-only group was associated with fibrosis and higher liver stiffness—independent of demographic and lifestyle factors. We believe that using the MAFLD criteria will help improve the identification and treatment of patients with FLD at risk for fibrosis.

AB - Background and Aims: Recently metabolic dysfunction–associated fatty liver disease (MAFLD) has been introduced and was defined as hepatic steatosis with either overweight, diabetes, and/or a combination of other metabolic risk factors. We investigated the application of the MAFLD criteria as compared with NAFLD. Approach and Results: We performed a cross-sectional analysis within the Rotterdam Study, a large prospective population-based cohort. Participants who attended the liver ultrasound and transient elastography program between 2009 and 2014 were eligible for inclusion. Subsequently, individuals with viral hepatitis, alcohol intake >60 g/day, missing alcohol data, and/or missing body mass index were excluded. According to their NAFLD and MAFLD status based on metadata and ultrasound, participants were allocated in overlap fatty liver disease (FLD), NAFLD-only, MAFLD-only, or no FLD. Fibrosis was defined as liver stiffness ≥8.0 kPa. In our analysis, 5445 participants were included: 1866 (34.3%) had MAFLD and 1604 (29.5%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1623 (29.8%)”] had NAFLD. This resulted in 1547 (28.4%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “1566 (28.8%)”] individuals with overlap FLD, 319 (5.9%) [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from “300 (5.5%)”] with MAFLD-only, 57 (1.0%) with NAFLD-only, and 3522 (64.7%) with no FLD. The MAFLD-only group was strongly associated with fibrosis (adjusted OR 5.30 [Correction added on December 27, 2021 after first online publication: The preceding fragment was changed from "OR 5.27"], p < 0.001) and log-transformed liver stiffness (adjusted beta 0.116, p < 0.001), as opposed to the NAFLD-only group, in which no cases of fibrosis were identified and no association with liver stiffness (adjusted beta 0.006, p = 0.90) was found. Conclusions: FLD is highly prevalent in the general population. However, not the NAFLD-only, but the MAFLD-only group was associated with fibrosis and higher liver stiffness—independent of demographic and lifestyle factors. We believe that using the MAFLD criteria will help improve the identification and treatment of patients with FLD at risk for fibrosis.

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Metabolic dysfunction–associated fatty liver disease improves detection of high liver stiffness: The Rotterdam Study

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