Clinical features and mortality outcomes of patients with MASLD only compared to those with MAFLD and MASLD

The applicability of the proposed metabolic dysfunction-associated steatotic liver disease (MASLD) definition has not been validated. We aimed to characterize the profiles and long-term survival of people meeting the criteria for MASLD, but not that of metabolic dysfunction-associated fatty liver disease (MAFLD), i.e. MASLD only.

Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988–1994, 7791 adult participants were included and categorized into four distinct groups: no SLD, non-MAFLD MASLD, MASLD–MAFLD, and cryptogenic SLD (steatosis without metabolic dysfunction).

Participants in the MASLD-only group were younger and had better metabolic profiles and fibrosis degree compared to those with MASLD–MAFLD and those with no SLD. Their profiles were comparable to those with cryptogenic SLD. Similarly, the MASLD-only group tend to have lower cumulative incidence of all-cause and cardiovascular mortality. Clustering analysis showed that MASLD only clusters differently from individuals with MASLD–MAFLD.

MASLD only is a distinct clinical group with substantial heterogeneity compared to those captured using the MAFLD criteria.