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Comparative effects of non-alcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease on risk of incident cardiovascular events: a meta-analysis of about 13 million individuals
  1. Alessandro Mantovani1,
  2. Alessandro Csermely1,
  3. Herbert Tilg2,
  4. Christopher D Byrne3,
  5. Giovanni Targher1
  1. 1Endocrinology and Metabolism, University of Verona School of Medicine and Surgery, Verona, Italy
  2. 2Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medizinische Universitat Innsbruck, Innsbruck, Austria
  3. 3University of Southampton Faculty of Medicine, Southampton, UK
  1. Correspondence to Professor Giovanni Targher, Endocrinology and Metabolism, Department of Medicine, University of Verona, Verona 37126, Italy; giovanni.targher{at}

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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 …

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  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.