Evidence map›Paper›PMID 39673677›Full record

ArticleHepatology international2025

MAFLD but not MASLD increases risk of all-cause mortality in regional Australia, with components of metabolic syndrome exacerbating factors: 20 year longitudinal, cohort study.

Karl Vaz, William Kemp, Ammar Majeed, John Lubel, Dianna J Magliano, Kristen M Glenister, Lisa Bourke, David Simmons, Stuart K Roberts

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Article in Hepatology international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Karl VazDepartment of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre,55 Commercial Road, Melbourne, VIC, 3004, Australia. k.vaz@alfred.org.au.ORCID http://orcid.org/0000-0002-6427-6140
William KempDepartment of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre,55 Commercial Road, Melbourne, VIC, 3004, Australia.
Ammar MajeedDepartment of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre,55 Commercial Road, Melbourne, VIC, 3004, Australia.
John LubelDepartment of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre,55 Commercial Road, Melbourne, VIC, 3004, Australia.
Dianna J MaglianoDiabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
Kristen M GlenisterDepartment of Rural Health, University of Melbourne, Parkville, VIC, Australia.
Lisa BourkeDepartment of Rural Health, University of Melbourne, Parkville, VIC, Australia.
David Simmons *Department of Rural Health, University of Melbourne, Parkville, VIC, Australia.
Stuart K Roberts *Department of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre,55 Commercial Road, Melbourne, VIC, 3004, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsControversy remains whether the mortality risk in people with fatty liver disease (FLD) including metabolic-(dysfunction) associated steatotic liver disease (MASLD) and metabolic-(dysfunction) associated fatty liver disease (MAFLD) is higher than observed in those without FLD. We aimed to determine the mortality rate and mortality rate ratio (MRR) for these FLDs.

methodsThe study population was a randomly selected cohort of community-dwelling adults in regional Victoria, Australia between 2001 and 2003 with sufficient data evaluable for Fatty Liver Index and determination on alcohol consumption. MASLD and MAFLD were diagnosed by established criteria. The primary outcome was overall mortality and main secondary outcome was major adverse liver outcomes (MALO) (i.e., decompensated liver disease, primary liver cancer and liver-related death). Non-fatal and fatal outcomes were captured via data linkage to hospital admission, cancer registry, and death registries. MRR was calculated with non-FLD participants as the comparator.

results1444 (99.3%) and 1324 (91.1%) individuals from a total of 1454 were included in the final MAFLD and MASLD analyses. The median follow-up was 19.7 years (IQR 19.1-20.1) and there were 298 deaths. The MRR for MAFLD and MASLD was 1.39 (95% CI 1.10-1.76) and 1.25 (95% CI 0.96-1.61), respectively. MAFLD persisted as a risk factor for all-cause death on multivariable models correcting for lifestyle and socioeconomic variables, but not when adjusted for metabolic risk factors. MALOs were increased in MAFLD [incidence rate ratio (IRR) 3.03, 95% CI 1.22-8.18] and MASLD (IRR 2.80, 95% CI 1.05-7.90). Metabolic risk factors increased the risk of overall mortality and MALO, and cancer (34.3-34.6%) and cardiovascular disease (30.1-33.7%) were the most common cause of death in FLD.

conclusionIn this population-based longitudinal study, MAFLD but not MASLD increases the risk of overall mortality, with metabolic syndrome components key risk factors increasing risk of death.

Indexed as

Fatty LiverMetabolic SyndromeNon-alcoholic Fatty Liver DiseaseAdultAgedCause of DeathFemaleHumansLongitudinal StudiesMaleMiddle AgedRisk FactorsVictoriaMAFLDMajor adverse liver outcomeMASLDMetabolic syndromeNAFLDOverall mortality

Identifiers

PMID39673677

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.