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

Abstract Aims Patients with fatty liver disease (FLD) frequently have metabolic risk factors; however, the clinical course of metabolic-associated FLD (MAFLD) in Asians is unclear. We compared the clinical courses of MAFLD and nonalcoholic FLD (NAFLD). Methods Asian FLD patients (n = 987) from 1991–2021 (biopsy-proven in 939, 497 males) were enrolled. The patients were divided into non-MAFLD/NAFLD (non-M/N, n = 92), both M/N (n = 785), and M/non-N (n = 90) groups. The clinical features, complications, and survival rates were compared among the three groups. Mortality risk factors were subjected to Cox regression analysis. Results 1) Non-M/N patients were significantly younger (non-M/N, M/N, and M/non-N 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/m2) and FIB-4 index (1.20, 1.46, and 2.10). Hypopituitarism (5.4%) and hypothyroidism (7.6%) were significantly observed in the non-M/N group. Hepatocellular carcinoma (HCC) developed in 0.0, 4.2, and 3.3% 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/non-N group (1, 37, and 11 cases, p < 0.01). Survival rates were not significantly different among the three groups. 2) The risk factors for mortality were age and BMI in the non-M/N group; age, HCC, alanine transaminase, and FIB-4 in the M/N group; and FIB-4 in the M/non-N group. Conclusions Although there was no significant difference in survival rates among the three groups of FLD, it should be considered that there would be different risk factors for mortality among the groups.