Abstract
OBJECTIVES: Metabolic-associated fatty liver disease (MAFLD) is becoming increasingly prevalent worldwide, however, early diagnosis and intervention remain underachieved. This study aims to guide the prevention and diagnosis of MAFLD by analysing its risk factors within the adult population from Suzhong Region, China. DESIGN: This was a cross-sectional study. SETTING: The study was conducted at the Health Management Department of Northern Jiangsu People's Hospital. PARTICIPANTS: A total of 49 776 asymptomatic Chinese participants (54.24% men) were enrolled. OUTCOME MEASURES: Hepatic ultrasonography was performed to diagnose MAFLD based on the latest diagnostic criteria. The relevant blood routine and biochemical indicators were collected. RESULTS: Among 49 776 participants, the prevalence of MAFLD was 29.89% (14 877/49 776). The results of restricted cubic spline (RCS) analysis showed a nonlinear relationship between age and MAFLD prevalence. As age increased, the overall trend of age in relation to MAFLD prevalence was initially increasing and then decreasing in the total study population and in males. In contrast, the overall trend of age in relation to MAFLD prevalence in females was initially increasing and then levelling off. The study found that age, body mass index (BMI), red blood cell (RBC) count, white blood cell (WBC) count, fasting blood glucose, albumin, total bilirubin, alanine aminotransferase (ALT), uric acid, triglycerides (TG) and low-density lipoprotein cholesterol were risk factors for MAFLD in adults, while aspartate aminotransferase, direct bilirubin, blood urea nitrogen, serum creatinine and high-density lipoprotein cholesterol were protective factors (p<0.05). Among these, BMI, ALT, TG, triglyceride-glucose index (TyG), triglyceride glucose-body mass index (TyG-BMI) and Atherogenic Index of Plasma (AIP) had excellent predictive value for the occurrence of MAFLD in adults (area under the curve was 0.834, 0.803, 0.809, 0.822, 0.880 and 0.824, respectively). The clinical applicability of important feature variables was assessed using decision curve analysis curves and confusion matrix, and the results showed that TyG-BMI had the highest clinical diagnostic and decision-making benefits. CONCLUSIONS: The occurrence of MAFLD has a nonlinear relationship with age and the trend of this relationship varies significantly between males and females. BMI, ALT, TG, TyG, TyG-BMI and AIP are helpful factors in the diagnosis of MAFLD, especially TyG-BMI. TRIAL REGISTRATION NUMBER: Clinical trials from the Northern Jiangsu People's Hospital (SBLC23002).