{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:09:36Z","timestamp":1790633376271,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:00:00Z","timestamp":1632960000000},"content-version":"am","delay-in-days":304,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP20fk0210040"],"award-info":[{"award-number":["JP20fk0210040"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006190","name":"Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006190","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001236","name":"Medical Foundation","doi-asserted-by":"publisher","award":["APP1107178"],"award-info":[{"award-number":["APP1107178"]}],"id":[{"id":"10.13039\/100001236","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001236","name":"Medical Foundation","doi-asserted-by":"publisher","award":["APP1108422"],"award-info":[{"award-number":["APP1108422"]}],"id":[{"id":"10.13039\/100001236","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Diagnostic criteria for metabolic associated fatty liver disease (MAFLD) have been proposed, but not validated. We aimed to compare the diagnostic accuracy of the MAFLD definition vs the existing NAFLD criteria to identify patients with significant fibrosis and to characterize the impact of mild alcohol intake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 765 Japanese patients with fatty liver (median age 54\u00a0years). MAFLD and NAFLD were diagnosed in 79.6% and 70.7% of patients respectively. Significant fibrosis was defined by FIB\u20104 index \u22651.3 and liver stiffness \u22656.6\u00a0kPa using shear wave elastography. Mild alcohol intake was defined as &lt;20\u00a0g\/day. Factors associated with significant fibrosis were analysed by logistic regression and decision\u2010tree analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Liver stiffness was higher in MAFLD compared to NAFLD (7.7 vs 6.8\u00a0kPa,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.0010). In logistic regression, MAFLD (OR 4.401; 95% CI 2.144\u201010.629;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.0001), alcohol intake (OR 1.761; 95% CI 1.081\u20102.853;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.0234), and NAFLD (OR 1.721; 95%CI 1.009\u20102.951;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.0463) were independently associated with significant fibrosis. By decision\u2010tree analysis, MAFLD, but not NAFLD or alcohol consumption was the initial classifier for significant fibrosis. The sensitivity for detecting significant fibrosis was higher for MAFLD than NAFLD (93.9% vs 73.0%). In patients with MAFLD, even mild alcohol intake was associated with an increase in the prevalence of significant fibrosis (25.0% vs 15.5%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.0181).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The MAFLD definition better identifies a group with fatty liver and significant fibrosis evaluated by non\u2010invasive tests. Moreover, in patients with MAFLD, even mild alcohol consumption is associated with worsening of hepatic fibrosis measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.14675","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T15:48:21Z","timestamp":1601480901000},"page":"3018-3030","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":374,"title":["MAFLD identifies patients with significant hepatic fibrosis better than NAFLD"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4879-0254","authenticated-orcid":false,"given":"Sakura","family":"Yamamura","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume 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