Increasing Prevalence of Metabolism-Associated Fatty Liver Disease in US Adults

Theodore C. Friedman, MD, PhD

Credit: LinkedIn

The rate of metabolism-associated fatty liver disease (MAFLD)the leading cause of liver disease, is increasing among adults in the United States, according to new research presented at ENDO 2023.¹

The results suggest that the Mexican American population consistently experienced the highest percentage of MAFLD, particularly in 2018, but the prevalence of the increase was higher among the white population.

“MAFLD affects Hispanics at a higher prevalence than blacks and whites,” said Theodore C. Friedman, MD, PhD, chair of the department of internal medicine at Charles R. Drew University of Medicine and Science, in a press release.¹ “Overall, the increase in MAFLD is concerning because this condition can lead to liver failure and cardiovascular disease and presents a significant health disparity.”

MAFLD was previously known as non-alcoholic fatty liver disease (NAFLD) and is rapidly becoming the most common indication for liver transplantation. The literature suggests that the term may better describe liver disease associated with known metabolic dysfunction.² The new definition of MAFLD refers to hepatic steatosis in addition to one of the following 3 criteria: overweight/obesity, presence of type 2 diabetes mellitus or evidence of a metabolic disorder.

The exclusion of other liver diseases, including alcoholic, autoimmune, or life-threatening hepatitis, is not a prerequisite for the diagnosis of MAFLD. When left untreated, MAFLD can lead to liver cancer and liver failure. Research shows that within the general population, the overall worldwide prevalence of MAFLD is estimated at 25%. Due to common risk factors, cardiac death is one of the leading causes of death in MAFLD patients.

In the current analysis, the survey team analyzed data from 32,726 National Health and Nutrition Survey (NHANES) participants from 1988 to 2018. Overall, MAFLD and obesity increased over time and the increase in MAFLD was greater than the increase in obesity. , according to the study’s first author, Magda Shaheen, MD, PhD, MPH, of the Charles R. Drew University of Medicine and Science.

Data showed that the percentage of people with MAFLD increased from 16% in 1988 to 37% in 2018 (a 131% increase). In contrast, the percentage of obesity increased from 23% in 1988 to 40% in 2018 (a 74% increase). The team noted that the prevalence of MAFLD was increasing faster than the prevalence of obesity, suggesting that the observed increase in risk factors, such as diabetes and hypertension, may further contribute to the increased prevalence of MAFLD.

By race and ethnicity, the percentage of MAFLD was higher at any time compared to the overall population among Mexican American patients. The analysis showed that the percentage increase in MAFLD in 2018 compared to 1988 was 133% among the white population, 61% among Mexican American patients, and 56% among the black population.

“In summary, MAFLD is increasing over time and more efforts are needed to control this outbreak,” Shaheen said.

The references

1. The prevalence of metabolically-associated fatty liver disease is increasing. In the news. June 16, 2023. Accessed June 16, 2023. https://www.newswise.com/articles/prevalence-of-metabolic-associated-fatty-liver-disease-is-increasing.
2. Sangro, P., de la Torre Aláez, M., Sangro, B. et al. Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD): An Update on Recent Advances in Pharmacological Treatment. J Physiol Biochem (2023). https://doi.org/10.1007/s13105-023-00954-4