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Changing from NAFLD to MASLD: Prevalence and progression of ASCVD risk are similar between NAFLD and MASLD in Asia

Hiroyuki Suzuki, Tsubasa Tsutsumiorcid, Machiko Kawaguchi, Keisuke Amano, Takumi Kawaguchi
Clinical and Molecular Hepatology 2024;30(3):577-579.
Published online: March 6, 2024

Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

Corresponding author : Tsubasa Tsutsumi Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan Tel: +81-942-31-7561, Fax: +81-942-34-2623, E-mail: tsutsumi_tsubasa@med.kurume-u.ac.jp

Editor: Mi Na Kim, Yonsei University College of Medicine, Korea

• Received: March 1, 2024   • Accepted: March 5, 2024

Copyright © 2024 by The Korean Association for the Study of the Liver

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Keywords: Non-alcoholic fatty liver disease; Metabolic dysfunction-associated steatotic liver disease; Cardiovascular diseases
    • Dear Editor,
    Patients with steatotic liver disease (SLD) associated with cardiometabolic dysregulation exhibit a higher incidence of extrahepatic diseases, including atherosclerotic cardiovascular disease (ASCVD) [1]. In June 2023, the consensus group composed of multiple societies opted to replace the term nonalcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD), aiming to minimize the potential for stigma and more accurately reflect its underlying pathophysiology [2]. MASLD requires a new inclusion criterion of “the presence of at least one or more cardiometabolic risk factors,” which reflects the importance of cardiometabolic dysregulation in patients with SLD [2,3]. While the use of alternative terminology can lead to occasional misunderstandings and hinder progress, it is crucial to extend investigations on NAFLD to MASLD. This will ensure that valuable research resources are effectively utilized and contribute to the advancement of knowledge in this field.
    We aimed to compare the prevalence and progression of ASCVD risk in patients with NAFLD and those with MASLD in Asia. This investigation included 7,286 consecutive health check examinees who were subjected to ultrasonography and monitored at the Saga Health and Clinical Examination Center (Saga, Japan) from January 2010 to March 2020. All the individuals were Asian. We eliminated 895 participants from our sample because of insufficient data on alcohol consumption habits (n=541), alcohol consumption ≥60 g/day (n=161), hepatitis B virus infection (n=81), and hepatitis C virus infection (n=112). The study population comprised 2,306 individuals diagnosed with SLD [4].
    NAFLD was diagnosed in 63.4% (1,462/2,306) of the patients, including 98 who did not fulfill the cardiometabolic criteria for MASLD (Fig. 1A). These cases were classified as cryptogenic SLD, and a significant proportion (93.3%) of patients with NAFLD were also diagnosed with MASLD. Our findings align well with those of previous studies that reported that almost all NAFLD patients fulfilled the MASLD criteria [5-7].
    There were no significant differences in age, sex, baseline Suita score, or Framingham risk score between the NAFLD and MASLD groups (Suita score, low/middle/high, 795/531/79 vs. 715/521/79, P=0.507; Framingham Risk Score, low/high, 1,025/239 vs. 948/235, P=0.543). We defined the event as worsening of the Suita score (from low-risk [≤40] to middlerisk [41–55] or high-risk [≥56]) [8] or Framingham risk score (from low-risk [<15] to high-risk [≥15]) [9]. To compare the incidence of worsening ASCVD risk scores between the groups, we constructed Kaplan–Meier curves (Fig. 1B, C). The rate of five-year/ten-year cumulative incidence of worsening scores was not significantly different between patients with NAFLD and those with MASLD (Fig. 1B, C). These results indicate that the prevalence and progression of ASCVD risk are similar in patients with MASLD and NAFLD. These results were similar to previous studies that have compared the differences between MASLD and NAFLD, accentuating the augmented risk of cardiovascular diseases, including ASCVD [1,10]. Although previous studies have reported from the U.S. and the EU, our report highlights similar importance in Asia.
    In conclusion, data on ASCVD obtained using the term NAFLD can be extrapolated to MASLD.
    This research was supported by the Japan Agency for Medical Research and Development (AMED) under grant number JP23fk0210090.

    Authors’ contribution

    Hiroyuki Suzuki and Tsubasa Tsutsumi: study concept, design, and drafting; Keisuke Amano: data extraction, interpretation of data, and critical revision of the manuscript; Machiko Kawaguchi: interpretation of data, statistical analysis, and interpretation of data and critical revision of the manuscript; Takumi Kawaguchi: study concept, interpretation of data and critical revision of the manuscript.

    Conflicts of Interest

    Takumi Kawaguchi received lecture fees from Janssen Pharmaceutical K.K., Taisho Pharmaceutical Co., Ltd., Kowa Company, Ltd., Otsuka Pharmaceutical Co., Ltd., Eisai Co., Ltd., ASKA Pharmaceutical Co., Ltd., AbbVie GK., and EA Pharma Co., Ltd. The other authors have no conflicts of interest to declare.

    Figure 1.
    Differences in the incidence of worsening atherosclerotic cardiovascular disease risk scores between the NAFLD and MASLD groups. (A) Prevalence of NAFLD and MASLD in the study cohort. (B, C) Differences in the incidence of worsening Suita score (B) and Framingham risk score (C) between the NAFLD and MASLD groups. MASLD, metabolic dysfunction-associated steatotic liver disease; NAFLD, non-alcoholic fatty liver disease; ASCVD, atherosclerotic cardiovascular disease.
    cmh-2024-0157f1.jpg

    SLD

    steatotic liver disease

    ASCVD

    atherosclerotic cardiovascular disease

    NAFLD

    nonalcoholic fatty liver disease

    MASLD

    metabolic dysfunction-associated steatotic liver disease
    • 1. Younossi ZM, Paik JM, Stepanova M, Ong J, Alqahtani S, Henry L. Clinical profiles and mortality rates are similar for metabolic dysfunction-associated steatotic liver disease and non-alcoholic fatty liver disease. J Hepatol 2024;80:694-701.
    • 2. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023;79:1542-1556.
    • 3. Kim GA, Moon JH, Kim W. Critical appraisal of metabolic dysfunction-associated steatotic liver disease: Implication of Janus-faced modernity. Clin Mol Hepatol 2023;29:831-843.
    • 4. Tsutsumi T, Eslam M, Kawaguchi T, Yamamura S, Kawaguchi A, Nakano D, et al. MAFLD better predicts the progression of atherosclerotic cardiovascular risk than NAFLD: Generalized estimating equation approach. Hepatol Res 2021;51:1115-1128.
    • 5. Suzuki H, Shimose S, Iwamoto H, Niizeki T, Kawaguchi T. Changing from NAFLD to MASLD: Similar prognosis of patients with HCC under atezolizumab/bevacizumab treatment between NAFLD and MASLD. Clin Mol Hepatol 2024;30:263-265.
    • 6. Suzuki H, Tanaka T, Yamaguchi S, Miwa K, Kawaguchi T. Changing from NAFLD to MASLD: Similar prognosis of unresectable extrahepatic gastrointestinal cancer under chemotherapy between NAFLD and MASLD. J Hepatol 2024;80:e150-e151.
    • 7. Hagström H, Vessby J, Ekstedt M, Shang Y. 99% of patients with NAFLD meet MASLD criteria and natural history is therefore identical. J Hepatol 2024;80:e76-e77.
    • 8. Nishimura K, Okamura T, Watanabe M, Nakai M, Takegami M, Higashiyama A, et al. Predicting coronary heart disease using risk factor categories for a Japanese urban population, and comparison with the framingham risk score: the suita study. J Atheroscler Thromb 2014;21:784-798.
    • 9. D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117:743-753.
    • 10. Lee HH, Lee HA, Kim EJ, Kim HY, Kim HC, Ahn SH, et al. Metabolic dysfunction-associated steatotic liver disease and risk of cardiovascular disease. Gut 2024;73:533-540.

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    Changing from NAFLD to MASLD: Prevalence and progression of ASCVD risk are similar between NAFLD and MASLD in Asia
    Clin Mol Hepatol. 2024;30(3):577-579.   Published online March 6, 2024
    DOI: https://doi.org/10.3350/cmh.2024.0157
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    Changing from NAFLD to MASLD: Prevalence and progression of ASCVD risk are similar between NAFLD and MASLD in Asia
    Clin Mol Hepatol. 2024;30(3):577-579.   Published online March 6, 2024
    DOI: https://doi.org/10.3350/cmh.2024.0157
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    Changing from NAFLD to MASLD: Prevalence and progression of ASCVD risk are similar between NAFLD and MASLD in Asia
    Image
    Figure 1. Differences in the incidence of worsening atherosclerotic cardiovascular disease risk scores between the NAFLD and MASLD groups. (A) Prevalence of NAFLD and MASLD in the study cohort. (B, C) Differences in the incidence of worsening Suita score (B) and Framingham risk score (C) between the NAFLD and MASLD groups. MASLD, metabolic dysfunction-associated steatotic liver disease; NAFLD, non-alcoholic fatty liver disease; ASCVD, atherosclerotic cardiovascular disease.

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    Changing from NAFLD to MASLD: Prevalence and progression of ASCVD risk are similar between NAFLD and MASLD in Asia
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