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.