Patients with metabolic-dysfunction associated fatty liver disease (MAFLD) without associated etiologies and non-MAFLD non-alcoholic fatty liver disease (NAFLD) have similar liver disease severity - Data from Indian Consortium on NAFLD (ICON-D).

Background and Aim: The suggested term of metabolic-dysfunction associated fatty liver disease (MAFLD) does not exclude alcohol and other associated etiologies. The severe liver disease described in MAFLD in comparison to non-MAFLD- NAFLD could be due to associated etiologies. Aim of the present study was to assess the differences in liver disease severity among patients with MAFLD without associated etiologies and non-MAFLD NAFLD. Methods: In an on-going real-life study of Indian Consortium on NAFLD (ICON-D), interim data across 41 centers over 3.5 years was analysed for differences in APRI, FIB-4, liver stiffness measurement (LSM), histological NAS and fibrosis scores among patients with non-MAFLD NAFLD and MAFLD defined as per suggested criteria but without alcohol and other associated etiologies. The study had ethical approval at respective centers and all patients gave an informed consent. Results: Of 5967 patients, 5292 (88.7%) had BMI≥ 23 kg/m2 and/or T2 DM and qualified as MAFLD. Of remaining 675 (11.3%) non-diabetic lean (BMI <23 kg/m2) patients, 343 (50.8%) had ≥ 2 MAFLD criteria and were also defined MAFLD and remaining 332 (49.2%) as non-MAFLD NAFLD. There was no difference in APRI- 0.38 (0.25 - 0.67) vs.0.44 (0.34-0.65) p=0.17 and FIB-4 - 1.05 (0.73 -1.6) vs. 0.92 (0.65 -1.52) p= 0.77 between MAFLD and non-MAFLD NAFLD. Using APRI (<0.5 and >1.5), FIB-4 (<1.3and >2.67) and LSM (<8 and >12 kPa), the proportion in whom advanced fibrosis was ruled out or ruled in was similar among non-MAFLD NAFLD and MAFLD. Histology analysis in 301 patients [non-MAFLD NAFLD: 27(8.9%), MAFLD:274(91%)] revealed no difference in mean NAS [4 ± 2.2 vs 4.4 ± 2.4, p=0.33] and no difference in the proportion with significant [‰¥F2, 8(29.6%) vs. 94(34%)] and advanced [‰¥F3, 2(7.4%) vs 25(9.1%)] fibrosis. Conclusions: There is no difference in the liver disease severity among patients with non-MAFLD-NAFLD and MAFLD without associated etiologies.