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J hePatol: Don’t miss it, patients with fatty liver may not have a modern metabolic syndrome!

Non -alcoholic fatty liver is the most common type of fatty liver in China. It has replaced hepatitis B and has become the largest chronic liver disease in China. However, due to the criticism of the name of the name, including the opposition to the dominant position of wine, etc., last year, experts from various countries reached a consensus to rename the non -alcoholic fatty liver disease (Nafld) to rename the fatty liver disease related to metabolic abnormalities ( MAFLD). Unlike NAFLD, diagnosis of MAFLD needs to find the following diseases related to metabolic -related diseases: ultra -weight/obesity, diabetes and metabolic disorders.

However, it seems that this new definition is not comprehensive enough. The liver research center of the First Affiliated Hospital of Fujian Medical University found that patients with liver fat degeneration will not have risk of metabolism and do not meet the diagnostic standards of MAFLD, but they will still suffer liver injury And liver fibrosis. The research center describes the clinical characteristics of this special group through the database. This result was published in J hepatol magazine.

Research methods

The Research Center uses the National Health Nutrition Survey (NHANES III) database. The survey allowed three doctors to evaluate the patient’s liver/gallbladder ultrasound image according to the following 5 indicators: substantive brightness, liver and kidney contrast, dark beam attenuation, bright blood vessel walls, gallbladder walls. Based on this, the patient’s liver has liver fat degeneration (mild, moderate, severe). Patients with no metabolic risk MAFLD (NON-MR-MAFLD) are patients with liver fat degeneration but without excessive drinking or any other metabolic risk.


Although the parameters related to metabolic patients in Non-MR-MAFLD are significantly lower, liver enzyme levels are equivalent to MAFLD patients. According to the AST and platelet ratio index (APRI) and the FIB-4 index, at least 10 patients with Non-MR-MAFLD patients with severe liver fat degeneration show advanced fibrosis symptoms, indicating that they also have liver injury. The above results show that those patients with severe liver fat but not diagnosed as MAFLD also have necrotic inflammation activities. Although there are only a small part of patients with severe liver fat degeneration, liver biopsy should still be performed to determine their liver injury and fibrosis.

It is worth noting that patients with Non-MR-MAFLD with severe liver fat degeneration average 10 years younger than MAFLD patients (35.13 ± 13.44 vs. 48.39 ± 15.20, P <0.001). They are often too young, have not developed mature metabolic metabolic disorders, and therefore will not be diagnosed as MAFLD. Severe liver fat degeneration can be regarded as early symptoms of metabolic disorders. If they do not intervene, they have high probability to develop MAFLD. Therefore, for patients with Non-MR-MAFLD, liver and extra-liver function tests should be performed to confirm their risk of metabolic diseases.

in conclusion

In general, patients with severe liver fat degeneration, although do not have metabolic syndrome and cannot be diagnosed with MAFLD, still have severe liver injury and liver fibrosis, and more attention should be given clinically. Only focusing on metabolic abnormalities may cause neglect of potential MAFLD patients, and more research on tissue pathology is also required to further describe the characteristics of patients with NON-MR-Nafld.

Primitive source:

Huang J, Kumar R, Wang M, zhu y, Lin S. Mafld Criteria Overlooks A Number of Patients with Severe Steatosis: Is it Clinically Relevant? J hepatol. 2020 nov; 73 (5): 1265-1267. Doi: 10.1016/j.jhep.2020.06.016. EPUB 2020 AUG 17. PMID: 32819754.

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