Clinical and sociodemographic characteristics of metabolic dysfunction-associated fatty liver subtypes in Malaysia

We aimed to describe the sociodemographic and clinical characteristics of subtypes of metabolic dysfunction-associated fatty liver disease (MAFLD) in Malaysia. Adults with MAFLD were identified from a 2023 nationwide community-based cross-sectional study. Three mutually exclusive MAFLD subtypes were classified first by diabetes status (diabetic MAFLD), then by ≥ 2 metabolic dysfunctions (metabolic dysfunction MAFLD), and finally by overweight/obesity with < 2 metabolic dysfunctions (overweight MAFLD). Among 309 respondents with MAFLD, the mean age was 46.8 ± 14.8 years, with a balanced sex distribution, and most were Malay (63.8%) and married or living with a partner (71.8%). The diabetic MAFLD subtype was characterised by older age, Indian ethnicity, and a higher proportion of divorced or widowed individuals, whereas younger adults were predominantly represented in the metabolic dysfunction subtype. Metabolic syndrome, hypertension, and raised total cholesterol were more common in the metabolic dysfunction subtype. The diabetic subtype had the highest waist circumference, blood pressure, triglycerides, glycosylated haemoglobin A1c, and fasting blood glucose. A higher proportion (22.7%) of the diabetic subtype had moderate or high risks of advanced liver fibrosis, compared to metabolic dysfunction (8.8%) and overweight (0.0%) subtypes, P = 0.002. Around 57.6% of the diabetic MAFLD subtype had a high 10-year cardiovascular risk compared to 25.8% and 10.0% in the metabolic dysfunction and overweight subtypes, respectively, P < 0.001. Individuals with diabetes, metabolic dysfunction, and overweight MAFLD subtypes in Malaysia had different sociodemographic characteristics and clinical profiles. MAFLD subtypes may be used for risk stratification, and individualised treatment may be considered for different subtypes.