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We read with interest the report on comparative risks of liver-related and cardiovascular disease (CVD) outcomes among lean and obese patients with non-alcoholic fatty liver disease (NAFLD) by Younes et al.1 Recently, international experts proposed redefining NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD).2 The impact of this name change on CVD risk prediction is not known.
We performed a meta-analysis of observational cohort studies (by searching PubMed, Scopus and Web of Science from database inception to 30 June 2022) that simultaneously used the NAFLD and MAFLD definitions for examining the risk of incident CVD events associated with both definitions, among adults with and without either NAFLD or MAFLD, and in which hepatic steatosis was diagnosed by imaging techniques or blood biomarkers/scores. Studies using liver biopsy were not available. The primary outcomes were CVD mortality, non-fatal CVD events or both. Data from selected studies were extracted, and meta-analysis was performed using random-effects models to obtain summary HRs with 95% CIs. In the case of studies reporting HRs with varying degrees of covariate adjustment, those reflecting the maximum extent of adjustment for confounding factors were extracted. The study was …
Footnotes
Contributors GT designed the study. AM, AC and GT did the literature search, with arbitration by AC. AM and GT analysed the data and did the figures. All authors interpreted the data. GT and CDB wrote the manuscript draft. All authors reviewed and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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