Outcomes of fatty liver disease with and without metabolic comorbidities and risk factors for mortality

BACKGROUND AND AIM: As the clinical course of metabolic‐associated fatty liver disease (MAFLD) is unclear, we compared the clinical courses of MAFLD and non‐alcoholic FLD (NAFLD). METHODS: Asian FLD patients (n = 987) from 1991 to 2021 (biopsy‐proven in 939) were enrolled. The patients were divided into NAFLD (N‐alone, n = 92), both MAFLD and N (M&N, n = 785), and M‐alone (n = 90) groups. Clinical features, complications, and survival rates were compared among the three groups. Risk factors of mortality were subjected to Cox regression analysis. RESULTS: The N‐alone group patients were significantly younger (N alone, M&N, and M alone: 50, 53, and 57 years, respectively), more frequently male (54.3%, 52.6%, and 37.8%), and had a low body mass index (BMI, 23.1, 27.1, and 26.7 kg/m(2)) and FIB‐4 index (1.20, 1.46, and 2.10). Hypopituitarism (5.4%) and hypothyroidism (7.6%) were significantly observed in the N‐alone group. Hepatocellular carcinoma (HCC) developed in 0.0%, 4.2%, and 3.5% of the cases, and extrahepatic malignancies in 6.8%, 8.4%, and 4.7% of the cases, respectively, with no significant differences. The cardiovascular event rate was significantly higher in the M‐alone group (1, 37, and 11 cases, P < 0.01). Survival rates were similar among the three groups. Risk factors for mortality were age and BMI in the N‐alone group; age, HCC, alanine transaminase, and FIB‐4 in the M&N group; and FIB‐4 in the M‐alone group. CONCLUSION: Different risk factors for mortality may exist among the FLD groups.