{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:52:06Z","timestamp":1785585126839,"version":"3.56.0"},"reference-count":49,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T00:00:00Z","timestamp":1688083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Re\u2010classifying NAFLD as metabolic\u2010associated fatty liver (MAFLD) has been proposed. While some people fulfil criteria for NAFLD, they do not have MAFLD; and whether NAFLD\u2010only subjects have increased the risk of type 2 diabetes remains unknown. We compared risk of incident T2D in individuals with: (a) NAFLD\u2010only; and (b) MAFLD, to individuals without fatty liver, considering effect modification by sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>246\u2009424 Koreans without diabetes or a secondary cause of ultrasound\u2010diagnosed hepatic steatosis were studied. Subjects were stratified into: (a) NAFLD\u2010only status and (b) NAFLD that overlapped with MAFLD (MAFLD). Cox proportional hazards models with incident T2D as the outcome were used to estimate hazard ratios (HRs) for: (a) and (b). Models were adjusted for time\u2010dependent covariates, and effect modification by sex was analysed in subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 5439 participants had NAFLD\u2010only status and 56\u2009839 met MAFLD criteria. During a median follow\u2010up of 5.5\u2009years, 8402 incident cases of T2D occurred. Multivariable\u2010adjusted HRs (95% CI) for incident T2D comparing NAFLD\u2010only and MAFLD to the reference (neither condition) were 2.39 (1.63\u20133.51) and 5.75 (5.17\u20136.36) (women), and 1.53 (1.25\u20131.88) and 2.60 (2.44\u20132.76) (men), respectively. The increased risk of T2D in the NAFLD\u2010only group was higher in women than in men (<jats:italic>p<\/jats:italic> for interaction by sex &lt;0.001) and consistently observed across all subgroups. Risk of T2D was increased in lean participants regardless of metabolic dysregulation (including prediabetes).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NAFLD\u2010only participants without metabolic dysregulation and the criteria for MAFLD are at increased risk of developing T2D. This association was consistently stronger in women than in men.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15661","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T12:15:50Z","timestamp":1688127350000},"page":"2445-2454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Nonalcoholic fatty liver disease without overlapping metabolic\u2010associated fatty liver disease and the risk of incident type 2 diabetes"],"prefix":"10.1111","volume":"43","author":[{"given":"Yoosun","family":"Cho","sequence":"first","affiliation":[{"name":"Total Healthcare Center, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoosoo","family":"Chang","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine  Seoul 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