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The objective was to identify MAFLD\/non\u2010MAFLD subjects with advanced liver disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two thousand two hundred and forty\u2010two (41.7%) of the 5378 subjects were identified as having MAFLD, and 375 (7.0%) had advanced liver disease. The proportions of anti\u2010HCV and HBsAg seropositivity were 19.3% and 9.7%, respectively. The proportions of advanced fibrosis in subjects with non\u2010viral hepatitis (NBNC), HBV and HCV infection were 2.8%, 5.7% and 23.4%, respectively. Subjects with MAFLD had a significantly higher proportion of advanced fibrosis (8.7% <jats:italic>vs<\/jats:italic> 5.7%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Factors associated with advanced fibrosis included age (odds ratio [OR]\/95% confidence interval [CI]: 4.8\/3.7\u20136.0, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), male sex (OR\/CI: 1.3\/1.0\u20131.7, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.019), anti\u2010HCV seropositivity (OR\/CI: 5.9\/4.6\u20137.5, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.019), MAFLD\u2010lean metabolic dysregulation (MS) (OR\/CI: 2.6\/1.3\u20135.2, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005; compared with the non\u2010MAFLD group) and MAFLD\u2010diabetes (OR\/CI: 1.5\/1.1\u20132.1, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.008; compared with the non\u2010MAFLD group). MAFLD did not aggravate liver disease severity in patients with viral hepatitis. However, among NBNC subjects, factors associated with advanced liver disease included MAFLD\u2010lean MS group (OR\/CI: 9.1\/2.4\u201334.6, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001; compared with non\u2010MAFLD group) and MAFLD\u2010DM group (OR\/CI: 2.0\/1.2\u20133.2, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.004; compared with non\u2010MAFLD group).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MAFLD patients with diabetes and metabolic dysregulation had a higher risk of advanced liver disease. The effect was more significant in non\u2010viral hepatitis subjects in a community level.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.16363","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T01:30:20Z","timestamp":1695259820000},"page":"193-201","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The interplay of metabolic dysfunction\u2010associated fatty liver disease and viral hepatitis on liver disease severity: A large community\u2010based study in a viral endemic area"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3367-068X","authenticated-orcid":false,"given":"Chung\u2010Feng","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatobiliary Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Program in Translational Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po\u2010Cheng","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatobiliary Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei\u2010Chien","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatobiliary Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2010Ju","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatobiliary Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Internal Medicine, Kaohsiung Municipal Ta\u2010Tung Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching\u2010I","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatobiliary Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4720-599X","authenticated-orcid":false,"given":"Chih\u2010Wen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hepatobiliary Kaohsiung Medical University Hospital, Kaohsiung 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