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1 "Hua-Fen Chen"
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Original Article
Comparison of all-cause mortality associated with non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease in Taiwan MJ cohort
Wei-Chun Cheng, Hua-Fen Chen, Hsiu-Chi Cheng, Chung-Yi Li
Epidemiol Health. 2024;46:e2024024.   Published online January 21, 2024
DOI: https://doi.org/10.4178/epih.e2024024
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  • 6 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The global burden of non-alcoholic fatty liver disease (NAFLD) is rising. An alternative term, metabolic dysfunction-associated fatty liver disease (MAFLD), instead highlights the associated metabolic risks. This cohort study examined patient classifications under NAFLD and MAFLD criteria and their associations with all-cause mortality.
METHODS
Participants who attended a paid health check-up (2012-2015) were included. Hepatic steatosis (HS) was diagnosed ultrasonographically. NAFLD was defined as HS without secondary causes, while MAFLD involved HS with overweight/obesity, type 2 diabetes mellitus, or ≥2 metabolic dysfunctions. Mortality was tracked via the Taiwan Death Registry until November 30, 2022.
RESULTS
Of 118,915 participants, 36.9% had NAFLD, 40.2% had MAFLD, and 32.9% met both definitions. Participants with NAFLD alone had lower mortality, and those with MAFLD alone had higher mortality, than individuals with both conditions. After adjustment for potential confounders, the hazard ratios (HRs) for all-cause mortality were 1.08 (95% confidence interval [CI], 0.78 to 1.48) for NAFLD alone and 1.26 (95% CI, 1.09 to 1.47) for MAFLD alone, relative to both conditions. Advanced fibrosis conferred greater mortality risk, with HRs of 1.93 (95% CI, 1.44 to 2.58) and 2.08 (95% CI, 1.61 to 2.70) for advanced fibrotic NAFLD and MAFLD, respectively. Key mortality risk factors for NAFLD and MAFLD included older age, unmarried status, higher body mass index, smoking, diabetes mellitus, chronic kidney disease, and advanced fibrosis.
CONCLUSIONS
All-cause mortality in NAFLD and/or MAFLD was linked to cardiometabolic covariates, with risk attenuated after multivariable adjustment. A high fibrosis-4 index score, indicating fibrosis, could identify fatty liver disease cases involving elevated mortality risk.
Summary
Key Message
In a cohort study involving 118,915 Taiwanese participants in a paid health check-up program, approximately one-third met both NAFLD (non-alcoholic fatty liver disease) and MAFLD (metabolic dysfunction-associated fatty liver disease) criteria. All-cause mortality associated with NAFLD and/or MAFLD correlated with cardiometabolic factors, though the risk attenuated following multivariable adjustment. A high fibrosis-4 index score, suggestive of liver fibrosis, was predictive of increased mortality risk in FLD (fatty liver disease) cases.

Citations

Citations to this article as recorded by  
  • Association Between Liver Fibrosis and Cause‐Specific Mortality in Japanese Patients With Biopsy‐Confirmed Metabolic Dysfunction–Associated Steatotic Liver Disease: A Prospective Cohort Study / Liver Fibrosis and Mortality in Japanese MASLD
    Kyoko Sakai, Toshihide Shima, Hirohisa Oya, Takahiro Miura, Shohei Amioka, Takahiro Nonaka, Shinsaku Fujiishi, Keiichiro Okuda, Kei Terasaki, Kohei Fukumoto, Yasuhide Mitsumoto, Masayuki Mizuno, Takeshi Okanoue
    Hepatology Research.2026; 56(1): 33.     CrossRef
  • Estudio de la asociación entre la enfermedad hepática metabólica y el deterioro de la función renal: Una revisión sistemática actualizada y metaanálisis de estudios prospectivos (2020–2025)
    I. Salcedo Joven, A. Fernández Ramos, S. Cinza Sanjurjo
    Medicina de Familia. SEMERGEN.2026; 52(5): 102779.     CrossRef
  • Genome-wide association study of the fatty liver index in the Taiwanese population reveals shared and population-specific genetic risk factors across ethnicities
    Pei Pei Lau, Chun-Yu Wei, Min-Rou Lin, Wan-Hsuan Chou, Yu-Jui Yvonne Wan, Wei-Chiao Chang
    Cell & Bioscience.2025;[Epub]     CrossRef
  • Emerging Trends in MAFLD and MASH
    Samita Garg, Nizar N. Zein
    Diabetes Technology & Therapeutics.2025; 27(S1): S227.     CrossRef
  • Machine learning for predicting all-cause mortality of metabolic dysfunction-associated fatty liver disease: a longitudinal study based on NHANES
    Xueni Wang, Huihui Chen, Luqiao Wang, Wenguang Sun
    BMC Gastroenterology.2025;[Epub]     CrossRef
  • MAFLD as a Cardiovascular Risk Factor: An Extended Retrospective Study with a Control Group
    Małgorzata Szymala-Pędzik, Marcin Piersiak, Maciej Pachana, Karolina Lindner-Pawłowicz, Wioletta Szczepaniak, Małgorzata Sobieszczańska
    Journal of Clinical Medicine.2025; 14(12): 4181.     CrossRef
  • Survival machine learning models for predicting all-cause and case-specific mortality risk in metabolic dysfunction-associated fatty liver disease patients
    Jingpeng Gao, Nan Zhang, Akemujiang Aximu, Ning Xin, Ziwei Wang, Ping Yan
    Scientific Reports.2025;[Epub]     CrossRef
  • Assessing Mortality Disparities Among Non-Alcoholic Fatty Liver Disease Metabolic Dysfunction Fatty Liver Disease and Metabolic Dysfunction-Associated Liver Disease: A Comprehensive Meta-Analysis
    Fahad Lakhdhir, Agha Syed Muhammad, Ahmed Nasir Qureshi, Imran A Shaikh, Imran Joher, Jawaria Majeed, Javaria Khan
    Cureus.2024;[Epub]     CrossRef
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