Outcomes of fatty liver disease with and without metabolic comorbidities and risk factors for mortality

Background and Aim As the clinical course of metabolic‐associated fatty liver disease (MAFLD) is unclear, we compared the clinical courses of MAFLD and non‐alcoholic FLD (NAFLD). Methods Asian FLD patients (n = 987) from 1991 to 2021 (biopsy‐proven in 939) were enrolled. The patients were divided into NAFLD (N‐alone, n = 92), both MAFLD and N (M&N, n = 785), and M‐alone (n = 90) groups. Clinical features, complications, and survival rates were compared among the three groups. Risk factors of mortality were subjected to Cox regression analysis. Results The N‐alone group patients were significantly younger (N alone, M&N, and M alone: 50, 53, and 57 years, respectively), more frequently male (54.3%, 52.6%, and 37.8%), and had a low body mass index (BMI, 23.1, 27.1, and 26.7 kg/m2) and FIB‐4 index (1.20, 1.46, and 2.10). Hypopituitarism (5.4%) and hypothyroidism (7.6%) were significantly observed in the N‐alone group. Hepatocellular carcinoma (HCC) developed in 0.0%, 4.2%, and 3.5% of the cases, and extrahepatic malignancies in 6.8%, 8.4%, and 4.7% of the cases, respectively, with no significant differences. The cardiovascular event rate was significantly higher in the M‐alone group (1, 37, and 11 cases, P