Endocrine Abstracts

Objectives: Metabolic dysfunction–associated fatty liver disease (MAFLD) is a new nomenclature for fatty liver disease (FLD). The clinical impact of the change in nomenclature on the ability to identify individuals at risk for cardiovascular disease (CVD) has not yet been elucidated. The aim of this study is to describe the cardiovascular risk and subclinical CVD of the different MAFLD subtypes.

Methods: Retrospective analysis of patients who attended a medical check-up at Clínica Universidad de Navarra between June 2003-December 2006 who had whole-body CT scan and analytics. Exclusion criteria included cerebral vascular diseases, heart disease, excessive alcohol consumption, advanced liver diseases and malignant disease. The cardiovascular risk was assessed through visceral adipose tissue (VAT)/subcutaneous adipose tissue (SCAT) Ratio. The presence of subclinical CVD was assessed by quantifying epicardial adipose tissue adjusted for body surface area (EATi) and Coronary Calcium according to Visual Scale (CAC-V).

Results: A total of 374 patients were included in the analysis: 154 without FLD and 220 with FLD. Mean age was 57.9±9.3 years and 71.4% (267/374) of the cohort were men. Of the FLD cohort: 12.7% (28/220) were patients without metabolic dysfunction (non-MD FLD), 69.5% (153/220) were patients with MAFLD due to the presence of overweight/obesity (MAFLD-overweight), 3.2% (7/220) were patients with MAFLD due to the presence of two metabolic abnormalities (MAFLD-MD) and 14.5% (32/220) were patients with MAFLD due to the presence of T2D (MAFLD-T2D). Compared with patients without FLD, patients with FLD had increased HOMA-IR, a more detrimental lipid profile, worse kidney and liver function (P<0.001) and a higher prevalence of metabolic syndrome disorders (P<0.001). MAFLD-T2D had significantly higher subclinical cardiovascular disease markers and cardiovascular risk, followed by MAFLD-overweight with metabolic dysfunction (MD) (VAT/SCAT Ratio: 1.070±0.456 and 0.889±0.291 [P<0.001]; EATi: 113.3±42.5 cm²and 108.2±46.9 cm²[P<0.001]; CAC-V: 3.3±3.4 and 1.87±2.61 [P<0.001], respectively). MAFLD-overweight without MD, MAFLD-MD, non-MD FLD and non-FLD had similar subclinical cardiovascular disease markers and cardiovascular risk (VAT/SCAT Ratio: 0.807±0.327, 0.794±0.420, 0.695±0.359 and 0.615±0.382 [P>0.05]; EATi: 82.3±33.5 cm², 78.6±39.9 cm², 57.1±27.0 cm²and 67.7±38.1 cm²[P>0.05]; CAC-V: 1.04 ±1.8,9, 1.14±1.77, 1.21±2.57 and 1.28±2.25 [P>0.05], respectively).

Conclusions: MAFLD–T2D and MAFLD–overweight with MD had the highest subclinical CVD and risk for CVD. Changing to the MAFLD criteria may help to stratify CVD risk and, therefore, aid clinicians in the task of reducing cardiovascular risk. Omitting a small fraction of individuals with metabolically uncomplicated FLD apparently does not confer an issue regarding heart outcomes.