Key result
Metabolically dysfunctional lean MAFLD is linked to ~2.8-fold higher adverse cardiovascular event risk.
Why the study?
Cardiovascular disease is the leading cause of death in MAFLD, motivating an investigation into CVD risk across MAFLD subgroups.
Does classification of MAFLD into subgroups by body mass index and metabolic status stratify the risk of high adverse cardiovascular events (HACE) in a Chinese health check-up population?
Cohort (n=23,945)
No
Does classification of MAFLD into subgroups by body mass index and metabolic status stratify the risk of high adverse cardiovascular events (HACE) in a Chinese health check-up population?
Answers are grounded in this paper and cite their sources.
In a Chinese health check-up cohort, metabolic-dysfunctional MAFLD subgroups (especially lean/normal weight MDL and overweight/obese MDO) are independently associated with higher predicted atherosclerotic cardiovascular disease risk.
Background: Cardiovascular disease (CVD) has emerged as the most significant complication and leading cause of death among metabolic-associated fatty liver disease (MAFLD). Objectives: This study aims to investigate the CVD risk among MAFLD subgroups. Design: Data of participants from June 2017 to January 2023 in the Physical Examination Center of the Third Hospital of Hebei Medical University were collected. MAFLD were divided into four subgroups: metabolic healthy lean/normal weight MAFLD (MHL), metabolic healthy overweight/obese MAFLD (MHO), metabolic dysfunctional lean/normal weight MAFLD (MDL), and metabolic dysfunctional overweight/obese MAFLD (MDO). Methods: The risk assessment for atherosclerotic CVD was performed based on the flowchart for primary prevention risk assessment in Chinese adults. Results: The proportions of MHL, MHO, MDL, and MDO were 0.77% ( n = 185), 10.05% ( n = 2406), 1.29% ( n = 310), and 16.86% ( n = 4038), respectively. After adjustment for gender, age, smoking history, drinking history, and significant liver fibrosis, the subgroup of MAFLD was still an independent risk factor for high adverse cardiovascular events (HACE). Compared with the MHL, the MDL had the highest risk, followed by MDO (all p < 0.05), and there was no significant difference between MHO and MHL. We performed regression analysis according to age (65 years) and gender (male or female), respectively, and the results were similar to those of the total population. Conclusion: MAFLD is associated with a higher risk of CVD, especially in MDO. Classification of MAFLD based on body mass index and metabolic status helps in risk stratification, which will mitigate or prevent the development of CVD.
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Dou et al. (2025) conducted a cohort in Metabolic-associated fatty liver disease (MAFLD) (n=23,945). Metabolic dysfunctional lean/normal weight MAFLD (MDL) vs. Metabolic healthy lean/normal weight MAFLD (MHL) was evaluated on High-risk adverse cardiovascular events (HACE) based on Chinese primary prevention ASCVD risk assessment (OR 2.758, 95% CI 1.710-4.449, p=<0.05). Metabolic dysfunctional lean/normal weight MAFLD was associated with the highest risk of high adverse cardiovascular events (OR 2.758, 95% CI 1.710-4.449) compared to metabolic healthy lean MAFLD.
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