MAFLD increases risk of mortality independent of excessive alcohol consumption

Metabolic dysfunction-associated fatty liver disease (MAFLD) raises the risk of death independently of excessive alcohol use, says an article published in Hepatology.

MAFLD is defined by metabolic dysfunction with steatosis, as well as the presence of secondary steatosis causes such as viral hepatitis (VH) or excessive alcohol intake. MAFLD is frequently associated with excessive alcohol intake, and its predictive significance in this population is unknown. Laurens van Kleef and colleagues undertook this study to evaluate the mortality risk of MAFLD in relation to excessive alcohol use and possible interactions.

25–74 years old persons were included in the National Health and Nutrition Examination Survey III cohort with accessible steatosis and alcohol data. Individuals with viral hepatitis, a BMI of 18.5, and missing data on age or followup were eliminated, leaving 12,656 participants with a median followup of 22.9 [20.9-24.8] years for analysis. Steatosis on ultrasonography in the context of metabolic failure was termed as MAFLD. A daily alcohol intake of 10 g in females and 20 g in males was deemed excessive. We calculated the risk of death from MAFLD and excessive alcohol drinking using multivariate Cox regression. Adjustments were made for gender, age, age squared, race, education, marital status, and smoking.

The key findings of this study were:

MAFLD was present in 31% of the population, while excessive alcohol use was present in 13%, and both were independently and concurrently related with higher mortality risk in fully adjusted models. 

Similarly, MAFLD was linked to a higher risk of death in both participants who drank excessively and those who did not. Individuals who had MAFLD as well as heavy alcohol intake (4.0%) had the greatest mortality risk. 

Using the first ten years of data, a strict definition of excessive alcohol consumption, and propensity score weighting, the results were consistent.

In conclusion, MAFLD raises the risk of death independent of alcohol use, and there was no impact modification in terms of mortality between MAFLD and excessive alcohol consumption. As a result, independent of drinking behaviors, MAFLD seems to be a significant entity.

Reference: 

van Kleef, L. A., de Knegt, R. J., & Brouwer, W. P. (2023). Metabolic dysfunction‐associated fatty liver disease and excessive alcohol consumption are both independent risk factors for mortality. In Hepatology (Vol. 77, Issue 3, pp. 942–948). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1002/hep.32642