MAFLD outperforms NAFLD in identifying metabolic dysfunction in U.S. adolescents: a NHANES 2017-2020 analysis.
Level 4 - case-series / case-control
Cross-sectional survey analysis
PubMed 40855535 · doi:10.1186/s12876-025-04170-w
What was done
This cross-sectional study analyzed US adolescents using data from the 2017–2020 cycle of the National Health and Nutrition Examination Survey (NHANES). The authors compared 532 metabolic-associated fatty liver disease (MAFLD) cases and 527 non-alcoholic fatty liver disease (NAFLD) cases to evaluate prevalence, clinical characteristics, risk factors via LASSO variable selection, and multivariate logistic regression associations.
What was found
MAFLD prevalence was 22.8% (95% CI: 18.8–26.8%) compared to 25.8% (95% CI: 21.5–30.0%) for NAFLD. Both definitions showed highest prevalence in Mexican Americans (40.6% MAFLD vs 42.9% NAFLD) and obese females (79.0% vs 78.1%). Compared with NAFLD cases, MAFLD cases had higher BMI (31.49 ± 6.63 vs 21.70 ± 4.18 kg/m²), higher HOMA-IR (5.44 ± 3.59 vs 2.48 ± 1.44), and higher ALT (21.85 ± 13.04 vs 14.36 ± 7.40 U/L; all p < 0.001). In multivariate logistic regression, MAFLD was significantly associated with metabolic abnormalities (OR = 3.46, 95% CI: 1.41–8.53, p = 0.011) and obesity (OR = 5.71, 95% CI: 1.08–30.35), whereas NAFLD associations were not statistically significant (metabolic abnormalities: OR = 1.45, 95% CI: 0.63–3.32, p = 0.364; obesity: OR = 2.24, 95% CI: 0.62–8.13).
Why it matters
Applying MAFLD definitions instead of NAFLD to adolescent populations may more effectively isolate youth with significant metabolic dysfunction and hepatic injury who require early clinical risk stratification.
Limits
The study is cross-sectional, preventing causal or temporal evaluation of disease progression. The total cohort denominator is not reported in the abstract. Fatty liver and metabolic classifications rely on survey and laboratory surrogates rather than histological verification.
Cited by
- context Approximately 25% of all children in the United States have non-alcoholic fatty liver disease.