Introduction Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is a recently suggested alternative to Non-alcoholic fatty liver disease (NAFLD). We compared baseline metabolic traits and outcomes of NAFLD and MAFLD. Methods In an ongoing, community-based, cohort study, participants were first screened in 2007 by structured-interview, anthropometry, liver ultrasonography, and biochemical/serological tests and reassessed after 7-years. Baseline characteristics and outcomes after 7-years were compared in NAFLD and MAFLD, in those excluded by the NAFLD definition but captured by the MAFLD definition and those excluded by the MAFLD definition but captured by the NAFLD definition, versus controls. Results Of 2985 recruited in 2007, 940 (31.5%) had NAFLD, 990 (33.1%) had MAFLD and 362 (12.1%) were controls. Compared to NAFLD, MAFLD captured an additional 2.9% of individuals from the cohort and lost 1.3%. At baseline, anthropometric and metabolic traits were similar in NAFLD and MAFLD. At follow-up after 7 years, the odds of having new-onset metabolic traits and fatal/non-fatal CVEs were similar in the two groups, but were significantly higher in both the groups compared to controls. However, those excluded by the NAFLD definition but captured by the MAFLD definition, showed higher baseline metabolic derangements compared to those excluded by the MAFLD definition but captured by the NAFLD definition and had higher odds for having new onset metabolic traits and CVEs compared to controls. Conclusion Even though it was able to increase the index population by only a small proportion, redefining NAFLD as MAFLD seemed to improve clinical utility.

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