Community-centered Disease Severity Assessment of Metabolic Dysfunction-associated Fatty Liver Disease

BACKGROUND AND AIMS: Disease severity across the different diagnostic categories of metabolic dysfunction-associated fatty liver disease (MAFLD) remains elusive. This study assessed the fibrosis stages and features of MAFLD between different items. We also aimed to investigate the associations between advanced fibrosis and risk factors. METHODS: This multicenter cross-sectional study enrolled adults participating in liver disease screening in the community. Patients were stratified following MAFLD diagnostic criteria, to group A (395 patients) for type 2 diabetes, group B (1,818 patients) for body mass index (BMI)>23 kg/m(2), and group C (44 patients) for BMI≤23 kg/m(2) with at least two metabolic factors. Advanced fibrosis was defined as a fibrosis-4 index>2.67. RESULTS: Between 2009 and 2020, 1,948 MAFLD patients were recruited, including 478 with concomitant liver diseases. Advanced fibrosis was observed in 125 patients. A significantly larger proportion of patients in group C (25.0%) than in group A (7.6%) and group B (5.8%) had advanced fibrosis (p<0.01). Logistic regression analysis found that hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection (odds ratio [OR]: 12.14, 95% confidence interval [CI]: 4.04–36.52; p<0.01), HCV infection (OR: 7.87, 95% CI: 4.78–12.97; p<0.01), group C (OR: 6.00, 95% CI: 2.53–14.22; p<0.01), and TC/LDL-C (OR: 1.21, 95% CI: 1.06–1.38; p<0.01) were significant predictors of advanced fibrosis. CONCLUSIONS: A higher proportion of lean MAFLD patients with metabolic abnormalities had advanced fibrosis. HCV infection was significantly associated with advanced fibrosis.