New definition of metabolic dysfunction-associated fatty liver disease with elevated brachial-ankle pulse wave velocity and albuminuria: a prospective cohort study

doi:10.1007/s11684-021-0888-8

Front. Med.

2022, Vol. 16

Issue (5) : 714-722 https://doi.org/10.1007/s11684-021-0888-8

RESEARCH ARTICLE

New definition of metabolic dysfunction-associated fatty liver disease with elevated brachial-ankle pulse wave velocity and albuminuria: a prospective cohort study

Jialu Wang^1,², Shanshan Liu^1,², Qiuyu Cao^1,², Shujing Wu^1,², Jingya Niu^1,², Ruizhi Zheng^1,², Lizhan Bie^1,², Zhuojun Xin^1,², Yuanyue Zhu^1,², Shuangyuan Wang^1,², Hong Lin^1,², Tiange Wang^1,², Min Xu^1,², Jieli Lu^1,², Yuhong Chen^1,², Yiping Xu³, Weiqing Wang^1,², Guang Ning^1,², Yu Xu^1,², Mian Li^1,²(

), Yufang Bi^1,²(

), Zhiyun Zhao^1,²(

)

¹. Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
². Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
³. Clinical Trials Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

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Abstract

A new definition of metabolic dysfunction-associated fatty liver disease (MAFLD) has recently been proposed. We aim to examine the associations of MAFLD, particularly its discordance from non-alcoholic fatty liver disease (NAFLD), with the progression of elevated brachial-ankle pulse wave velocity (baPWV) and albuminuria in a community-based study sample in Shanghai, China. After 4.3 years of follow-up, 778 participants developed elevated baPWV and 499 developed albuminuria. In comparison with the non-MAFLD group, the multivariable adjusted odds ratio (OR) of MAFLD group for new-onset elevated baPWV was 1.25 (95% confidence interval (CI) 1.01–1.55) and 1.35 (95% CI 1.07–1.70) for albuminuria. Participants without NAFLD but diagnosed according to MAFLD definition were associated with higher risk of incident albuminuria (OR 1.77; 95% CI 1.07–2.94). Patients with MAFLD with high value of hepamet fibrosis score or poor-controlled diabetes had higher risk of elevated baPWV or albuminuria. In conclusion, MAFLD was associated with new-onset elevated baPWV and albuminuria independently of body mass index, waist circumference, and hip circumference. Individuals without NAFLD but diagnosed as MAFLD had high risk of albuminuria, supporting that MAFLD criteria would be practical for the evaluation of long-term risk of subclinical atherosclerosis among fatty liver patients.

Keywords metabolic dysfunction-associated fatty liver disease non-alcoholic fatty liver disease fibrosis score brachial-ankle pulse wave velocity albuminuria

Corresponding Author(s): Mian Li,Yufang Bi,Zhiyun Zhao

Just Accepted Date: 18 March 2022 Online First Date: 09 May 2022 Issue Date: 18 November 2022

Cite this article:

Jialu Wang,Shanshan Liu,Qiuyu Cao, et al. New definition of metabolic dysfunction-associated fatty liver disease with elevated brachial-ankle pulse wave velocity and albuminuria: a prospective cohort study[J]. Front. Med., 2022, 16(5): 714-722.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0888-8
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I5/714

Fig.1 Flow diagram of the study population.

Characteristics	Overall (n = 6394)	Presence of MAFLD at baseline
Characteristics	Overall (n = 6394)	No (n = 4439)	Yes (n = 1955)	P value
Age (year)	58.00 ± 8.72	58.00 ± 8.94	58.00 ± 8.19	0.99
Men, n (%)	2333 (36.5)	1609 (36.2)	724 (37.0)	0.55
≥ 9 years of education, n (%)	4111 (64.6)	2841 (64.2)	1270 (65.4)	0.37
Current drinking, n (%)	622 (10.1)	427 (10.0)	195 (10.3)	0.70
Current smoking, n (%)	1240 (20.1)	856 (20.0)	384 (20.3)	0.80
Physical activity (MET-h/wk)	23.10 (4.95–93.1)	23.10 (4.95–102.20)	23.10 (3.30–74.20)	0.003
BMI (kg/m²)	25.23 ± 3.26	24.20 ± 2.80	27.56 ± 3.00	< 0.0001
Waist circumference (cm)	82.69 ± 8.86	79.87 ± 7.80	89.09 ± 7.74	< 0.0001
Hip circumference (cm)	94.03 ± 5.78	92.58 ± 5.12	97.34 ± 5.82	< 0.0001
SBP (mmHg)	141.43 ± 19.84	139.18 ± 19.75	146.53 ± 19.09	< 0.0001
DBP (mmHg)	83.06 ± 10.31	81.81 ± 10.14	85.90 ± 10.12	< 0.0001
Platelets ( ×1000/μL)	216.02 ± 63.21	212.83 ± 63.75	223.25 ± 61.37	< 0.0001
FPG (mmol/L)	5.18 (4.79–5.75)	5.07 (4.72–5.53)	5.53 (5.01–6.43)	< 0.0001
2h-PG (mmol/L)	6.97 (5.68–9.14)	6.54 (5.37–8.07)	8.57 (6.72–12.28)	< 0.0001
HbA1c (%)	5.60 (5.40–6.00)	5.60 (5.40–5.80)	5.80 (5.50–6.30)	< 0.0001
Triglycerides (mmol/L)	1.38 (0.99–1.95)	1.22 (0.90–1.68)	1.86 (1.36–2.59)	< 0.0001
Total cholesterol (mmol/L)	5.36 ± 1.01	5.30 ± 0.96	5.51 ± 1.09	< 0.0001
LDL-cholesterol (mmol/L)	3.21 ± 0.86	3.17 ± 0.84	3.31 ± 0.91	< 0.0001
HDL-cholesterol (mmol/L)	1.32 ± 0.32	1.38 ± 0.32	1.21 ± 0.27	< 0.0001
ALT (IU)	18.20 (14.00–25.50)	16.70 (13.00–22.10)	23.60 (17.50–34.50)	< 0.0001
AST (IU)	21.60 (18.40–25.60)	21.10 (18.10–24.90)	22.40 (19.10–27.50)	< 0.0001
GGT (IU)	21.00 (15.00–34.00)	19.00 (14.00–28.00)	30.00 (21.00–48.00)	< 0.0001
ACR (mg/g)	4.88 (2.80–8.99)	4.55 (2.65–8.17)	5.83 (3.16–11.69)	< 0.0001
baPWV (cm/s)	1603.62 ± 355.01	1573.85 ± 350.00	1671.27 ± 357.13	< 0.0001
Diabetes, n (%)	1245 (19.5)	548 (12.4)	697 (35.7)	< 0.0001
Insulin use, n (%)	44 (0.7)	33 (0.7)	13 (0.7)	0.88
Antihypertensive medication^a, n (%)	360 (5.6)	187 (4.2)	173 (8.9)	< 0.0001
Lipid-lowering medication, n (%)	16 (0.3)	9 (0.2)	7 (0.4)	0.25

Tab.1 General characteristics of the study population according to the presence of MAFLD at baseline

Tab.2 Risk of incident elevated baPWV and albuminuria according to MAFLD status

Tab.3 Risk of incident elevated baPWV and albuminuria according to concordant or discordant criteria from MAFLD and NAFLD definitions

Fig.2 Risks of incident elevated baPWV and albuminuria according to MAFLD status with different levels of HFS. ORs (95% CIs) were adjusted for age, sex, current smoking, current drinking, education, physical activity, BMI, waist circumference, hip circumference, and medications (insulin, antihypertensive, and lipid-lowering medications). baPWV, brachial-ankle pulse wave velocity; BMI, body mass index; CI, confidence interval; HFS, hepamet fibrosis score; MAFLD, metabolic dysfunction-associated fatty liver disease; OR, odds ratio.

Fig.3 Risks of incident elevated baPWV and albuminuria according to MAFLD with subtypes of glycemic status. ORs (95% CIs) were adjusted for age, sex, current smoking, current drinking, education, physical activity, BMI, waist circumference, hip circumference, and medications (antihypertensive and lipid-lowering medications). baPWV, brachial-ankle pulse wave velocity; BMI, body mass index; CI, confidence interval; MAFLD, metabolic dysfunction-associated fatty liver disease; OR, odds ratio.

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