MAFLD Shows Stronger Association with Diabetes and Hypertension Than NAFLD and MASLD: Study Finds

"The comparative analysis of MASLD, MetALD, MAFLD, and NAFLD showed that MAFLD had the strongest link to metabolic disorders, including type 2 diabetes (OR 7.02), hypertension (OR 3.45), and hyperlipidemia. MASLD and NAFLD followed, with diabetes risk ORs of 6.30 and 3.37, respectively," the researchers reported. "Moderate-to-severe liver steatosis further elevated diabetes risk across all categories, reinforcing MAFLD’s potential as a reliable predictor of metabolic dysfunction."

The research, conducted by Hong-ye Peng and colleagues from the Graduate School at Beijing University of Chinese Medicine, compared clinical characteristics and relative metabolic risk in individuals diagnosed with Metabolic dysfunction-associated steatotic liver disease (MASLD), Metabolic alcohol-related liver disease (MetALD), Metabolic associated fatty liver disease (MAFLD), and Nonalcoholic fatty liver disease (NAFLD).

Using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle, the team analyzed a cohort of 1,862 individuals to assess the associations between these liver disease classifications and common metabolic conditions such as type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia.

The study led to the following findings:

• MAFLD showed the strongest association with type 2 diabetes (OR 7.02), followed by MASLD (OR 6.36) and NAFLD (OR 3.37).
• For hypertension, MAFLD again had the highest correlation (OR 3.46), followed by MASLD (OR 2.89), NAFLD (OR 1.98), and MetALD (OR 1.80).
• MAFLD emerged as a more accurate clinical marker for assessing metabolic risk than other liver disease definitions.
• Moderate to severe liver steatosis significantly increased the risk of type 2 diabetes across all groups.
• Patients with MASLD and advanced steatosis had an OR of 3.92 for T2DM; MAFLD and NAFLD groups showed similar risks with ORs of 3.81 and 4.91, respectively.
• Individuals with MASLD or MetALD typically had higher BMI and greater metabolic dysfunction, highlighting the need for early detection and monitoring.

The authors conclude that the newer definitions of MASLD and MetALD are clinically relevant and merit continued investigation. However, MAFLD, due to its strong link with metabolic complications and steatosis severity, stands out as a more effective screening tool for identifying high-risk individuals. These insights could help refine diagnostic criteria and improve preventive strategies in metabolic and liver disease management.

“MAFLD shows greater predictive value in identifying individuals at increased risk for common metabolic disorders,” the researchers noted, underscoring the potential utility of this classification in guiding future clinical decision-making.

Reference:

Peng, Hy., Lu, Cl., Zhao, M., et al. Clinical characteristics of MASLD/MetALD/MAFLD/NAFLD and the relative risk analysis on metabolic disorders. BMC Gastroenterol 25, 372 (2025). https://doi.org/10.1186/s12876-025-03912-0