Predictors of metabolic-associated fatty liver disease (MAFLD) in adults: a population-based study in Northeastern Iran

AIM: This study aimed to identify the risk factors of metabolic (dysfunction)-associated fatty liver disease (MAFLD) among adults in northeastern Iran. BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and hepatic manifestation of metabolic syndrome that threatens global public health. Recently, MAFLD has been proposed as a new terminology updated from NAFLD and diagnosed based on modified criteria. METHODS: A nested case-control study was performed on the participants of the first phase of the Persian Sabzevar Cohort Study (PSCS), a survey that was conducted in northeastern Iran and enrolled 4,242 participants aged 35-70 years. In total, 968 MAFLD cases and 964 controls adjusted for age and sex were recruited. Data including demographic, lifestyle, anthropometric, biochemical, sleep pattern, and dietary intake information was collected. RESULTS: The mean (SD [standard deviation]) age of participants was 49.2 (8.8) years, and 39.9% of the participants were males. The prevalence of MAFLD was 22.8% (95% CI [confidence interval] 19.2 – 26.3%). Increased body mass index (BMI) (OR [odds ratios] 5.51, 95% CI 2.73 – 11.10), waist circumference (WC) (OR 1.85, 95% CI 1.44 – 2.38), blood concentrations of triglycerides (TG) (OR 1.10, 95% CI 1.06 – 1.15), total cholesterol (TC) (OR 1.02, 95% CI 1.003 – 1.04), and alanine aminotransferase (AST) (OR 1.10, 95% CI 1.05 – 1.16) were significantly associated with an increased risk of the MAFLD (p-value <0.05). Furthermore, the odds of MAFLD risk was 43% higher in subjects who slept ≤ 5 hrs/day than those with ≥ 7 hrs per day of sleep (OR 1.43; 95% CI 1.07 – 1.92, p-value = 0.01). CONCLUSION: In this study, it was found that MAFLD was best predicted by BMI, WC, and serum levels of TG, total cholesterol, and AST. Sleeping ≤ 5hrs/day compared to ≥ 7hrs/day was associated with an increased risk of MAFLD.