Related Experiment Video
Updated: Jul 26, 2025
Segmentation and Linear Measurement for Body Composition Analysis using Slice-O-Matic and Horos
Published on: March 21, 2021
MAFLD might be better in identifying subjects with sarcopenia or cardiovascular risk than NAFLD: A nationwide study
Eugene Han1, Ho Soo Chun2,3, Yong-Ho Lee3,4
1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.
Background And Aim:
Clinical features of non-alcoholic fatty liver disease (NAFLD), but not fulfilling the diagnostic criteria of metabolic dysfunction-associated fatty liver disease (MAFLD), remain unclear. We investigated the risk of sarcopenia and cardiovascular disease (CVD) in MAFLD and non-metabolic risk (MR) NAFLD.
Methods:
Subjects were selected from the Korean National Health and Nutrition Examination Surveys 2008-2011. Liver steatosis was assessed using fatty liver index. Significant liver fibrosis was defined using fibrosis-4 index, categorized by age cut-offs. Sarcopenia was defined as the lowest quintile sarcopenia index. Atherosclerotic CVD (ASCVD) risk score > 10% was defined as high probability.
Results:
A total of 7248 subjects had fatty liver (137 with non-MR NAFLD, 1752 with MAFLD/non-NAFLD, and 5359 with overlapping MAFLD and NAFLD). In non-MR NAFLD group 28 (20.4%) had significant fibrosis. The risk of sarcopenia (adjusted odds ratio [aOR] = 2.71, 95% confidence index [CI] = 1.27-5.78) and high probability of ASCVD (aOR = 2.79, 95% CI = 1.23-6.35) was significantly higher in MAFLD/non-NAFLD group than in non-MR NAFLD group (all P < 0.05). The risk of sarcopenia and high probability of ASCVD was similar between subjects with and without significant fibrosis in non-MR NAFLD group (all P > 0.05). However, the risk was significantly higher in MAFLD group than in non-MR NAFLD group (aOR = 3.38 for sarcopenia and 3.73 for ASCVD; all P < 0.05).
Conclusions:
The risks of sarcopenia and CVD were significantly higher in MAFLD group but did not differ according to fibrotic burden in non-MR NAFLD group. The MAFLD criteria might be better for identifying high-risk fatty liver disease than the NAFLD criteria.
Insights
Metabolic dysfunction-associated fatty liver disease (MAFLD) poses higher risks for sarcopenia and cardiovascular disease (CVD) compared to non-metabolic risk non-alcoholic fatty liver disease (NAFLD). MAFLD criteria may better identify high-risk fatty liver patients.
Area of Science:
- Hepatology
- Metabolic Syndrome
- Cardiovascular Health
Background:
- Non-alcoholic fatty liver disease (NAFLD) clinical features without metabolic dysfunction criteria are not well understood.
- Metabolic dysfunction-associated fatty liver disease (MAFLD) is a distinct entity requiring further investigation.
- The comparative risks of sarcopenia and cardiovascular disease (CVD) between MAFLD and non-metabolic risk NAFLD are unclear.
Purpose of the Study:
- To investigate the risks of sarcopenia and CVD in patients with MAFLD versus those with NAFLD but without metabolic dysfunction (non-MR NAFLD).
- To compare the diagnostic utility of MAFLD criteria versus NAFLD criteria in identifying high-risk individuals.
Main Methods:
- Utilized data from the Korean National Health and Nutrition Examination Surveys (2008-2011).
- Assessed liver steatosis using the fatty liver index and significant liver fibrosis using the fibrosis-4 index.
- Defined sarcopenia based on the lowest quintile of the sarcopenia index and high atherosclerotic CVD (ASCVD) risk as a score >10%.
Main Results:
- The MAFLD group exhibited significantly higher risks of sarcopenia (aOR=3.38) and high ASCVD probability (aOR=3.73) compared to the non-MR NAFLD group.
- In the non-MR NAFLD group, risks of sarcopenia and high ASCVD probability did not differ based on the presence of significant fibrosis.
- The MAFLD/non-NAFLD group also showed significantly higher risks of sarcopenia (aOR=2.71) and high ASCVD probability (aOR=2.79) compared to the non-MR NAFLD group.
Conclusions:
- MAFLD is associated with significantly elevated risks of sarcopenia and CVD.
- Fibrotic burden did not influence these risks within the non-MR NAFLD group.
- The MAFLD classification appears more effective than NAFLD criteria for identifying individuals at higher risk of sarcopenia and CVD.
