Effect of metabolic dysfunction‐associated fatty liver disease on liver cancer risk in a population with chronic hepatitis B virus infection: A nationwide study

Background The association between metabolic dysfunction‐associated fatty liver disease (MAFLD) and hepatocellular carcinoma (HCC) lacks clinical validation in at‐risk populations. We assessed this relationship among chronic hepatitis B (CHB) patients. Methods Data was collected from the National Health Insurance System database in South Korea. Chronic hepatitis B patients aged over 40 years receiving health examinations between 2011 and 2012 were recruited. The primary outcome was HCC. Metabolic dysfunction‐associated fatty liver disease was defined as hepatic steatosis in combination with at least one of the following: (i) overweight, (ii) diabetes, or (iii) lean/normal weight with two or more metabolic components. Multivariable Cox regression analysis was used to estimate adjusted hazard ratios (aHRs). Results Of 197 346 participants, 66 149 had MAFLD; 19 149, 44 475, and 2525 fulfilled diabetes (regardless of overweight), overweight alone, and lean/normal weight with two or more metabolic components, respectively. During follow‐up (median 7 years), 13 771 developed HCC. Metabolic dysfunction‐associated fatty liver disease was independently associated with increased risk of HCC, with aHR of 1.36 (p