Clin Mol Hepatol > Volume 30(3); 2024 > Article
Suzuki, Tsutsumi, Kawaguchi, Amano, and Kawaguchi: Changing from NAFLD to MASLD: Prevalence and progression of ASCVD risk are similar between NAFLD and MASLD in Asia
Dear Editor,
Patients with steatotic liver disease (SLD) associated with cardiometabolic dysregulation exhibit a higher incidence of extrahepatic diseases, including atherosclerotic cardiovascular disease (ASCVD) [1]. In June 2023, the consensus group composed of multiple societies opted to replace the term nonalcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD), aiming to minimize the potential for stigma and more accurately reflect its underlying pathophysiology [2]. MASLD requires a new inclusion criterion of “the presence of at least one or more cardiometabolic risk factors,” which reflects the importance of cardiometabolic dysregulation in patients with SLD [2,3]. While the use of alternative terminology can lead to occasional misunderstandings and hinder progress, it is crucial to extend investigations on NAFLD to MASLD. This will ensure that valuable research resources are effectively utilized and contribute to the advancement of knowledge in this field.
We aimed to compare the prevalence and progression of ASCVD risk in patients with NAFLD and those with MASLD in Asia. This investigation included 7,286 consecutive health check examinees who were subjected to ultrasonography and monitored at the Saga Health and Clinical Examination Center (Saga, Japan) from January 2010 to March 2020. All the individuals were Asian. We eliminated 895 participants from our sample because of insufficient data on alcohol consumption habits (n=541), alcohol consumption ≥60 g/day (n=161), hepatitis B virus infection (n=81), and hepatitis C virus infection (n=112). The study population comprised 2,306 individuals diagnosed with SLD [4].
NAFLD was diagnosed in 63.4% (1,462/2,306) of the patients, including 98 who did not fulfill the cardiometabolic criteria for MASLD (Fig. 1A). These cases were classified as cryptogenic SLD, and a significant proportion (93.3%) of patients with NAFLD were also diagnosed with MASLD. Our findings align well with those of previous studies that reported that almost all NAFLD patients fulfilled the MASLD criteria [5-7].
There were no significant differences in age, sex, baseline Suita score, or Framingham risk score between the NAFLD and MASLD groups (Suita score, low/middle/high, 795/531/79 vs. 715/521/79, P=0.507; Framingham Risk Score, low/high, 1,025/239 vs. 948/235, P=0.543). We defined the event as worsening of the Suita score (from low-risk [≤40] to middlerisk [41–55] or high-risk [≥56]) [8] or Framingham risk score (from low-risk [<15] to high-risk [≥15]) [9]. To compare the incidence of worsening ASCVD risk scores between the groups, we constructed Kaplan–Meier curves (Fig. 1B, C). The rate of five-year/ten-year cumulative incidence of worsening scores was not significantly different between patients with NAFLD and those with MASLD (Fig. 1B, C). These results indicate that the prevalence and progression of ASCVD risk are similar in patients with MASLD and NAFLD. These results were similar to previous studies that have compared the differences between MASLD and NAFLD, accentuating the augmented risk of cardiovascular diseases, including ASCVD [1,10]. Although previous studies have reported from the U.S. and the EU, our report highlights similar importance in Asia.
In conclusion, data on ASCVD obtained using the term NAFLD can be extrapolated to MASLD.


This research was supported by the Japan Agency for Medical Research and Development (AMED) under grant number JP23fk0210090.


Authors’ contribution
Hiroyuki Suzuki and Tsubasa Tsutsumi: study concept, design, and drafting; Keisuke Amano: data extraction, interpretation of data, and critical revision of the manuscript; Machiko Kawaguchi: interpretation of data, statistical analysis, and interpretation of data and critical revision of the manuscript; Takumi Kawaguchi: study concept, interpretation of data and critical revision of the manuscript.
Conflicts of Interest
Takumi Kawaguchi received lecture fees from Janssen Pharmaceutical K.K., Taisho Pharmaceutical Co., Ltd., Kowa Company, Ltd., Otsuka Pharmaceutical Co., Ltd., Eisai Co., Ltd., ASKA Pharmaceutical Co., Ltd., AbbVie GK., and EA Pharma Co., Ltd. The other authors have no conflicts of interest to declare.

Figure 1.
Differences in the incidence of worsening atherosclerotic cardiovascular disease risk scores between the NAFLD and MASLD groups. (A) Prevalence of NAFLD and MASLD in the study cohort. (B, C) Differences in the incidence of worsening Suita score (B) and Framingham risk score (C) between the NAFLD and MASLD groups. MASLD, metabolic dysfunction-associated steatotic liver disease; NAFLD, non-alcoholic fatty liver disease; ASCVD, atherosclerotic cardiovascular disease.



steatotic liver disease
atherosclerotic cardiovascular disease
nonalcoholic fatty liver disease
metabolic dysfunction-associated steatotic liver disease


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