Background  An international panel of experts has recommended that MAFLD would be a more appropriate term to describe this liver disease associated with metabolic disorders. Unlike NAFLD, MAFLD has its own set of positive criteria for diagnosing fatty liver disease. While the severity of fatty liver is often described by fibrosis stage, patients with mild steatosis on biopsy and no histological evidence of NASH have a better prognosis, and severe fibrosis is a major determinant of adverse outcomes in patients with MAFLD. However, there are few studies on the factors leading to MAFLD's significant fibrosis at home and abroad.

  Objective  To verify the influence of alcohol consumption and metabolic factors on MAFLD with significant fibrosis in large Chinese population.

  Methods  The information of patients who were admitted to the Physical Examination Center of Chinese PLA General Hospital from 2011 to 2021 was collected. The clinical differences in laboratory indicators and lifestyle between MAFLD and non-MAFLD, and the differences in significant fibrosis in MAFLD with different drinking habits were analyzed. Logistic univariate and multivariate analysis of independent risk factors for MAFLD significant fibrosis were performed.

  Results  A total of 36 847 subjects were included, with a mean age of 47.3 years, and 66.4% of them (24 479/36 847) were male. The prevalence of MAFLD was 37.1% (13 672/36 847) with a mean age of 47.9 years, with male accounting for 84.0% (11 478/13 672). The proportion of significant fibrosis in the MAFLD patients with one metabolic abnormality was higher than that in the patients without other metabolic abnormalities (15.2% vs 0, P < 0.001). Significant MAFLD fibrosis were associated with male (OR=1.808; 95%CI: 1.541-2.121; P < 0.001), advanced age (OR=1.151; 95%CI: 1.142-1.16; P < 0.001), drinking (OR=1.167; 95%CI: 1.046-1.301; P=0.006), and diabetes (OR=1.155; 95%CI: 1.007-1.324; P=0.040). The proportion of significant liver fibrosis was higher in the mild alcohol group than that in the non-alcohol group (16.5% vs 14.2%, P=0.009).

  Conclusion   MAFLD with metabolic comorbidities displays a higher incidence of significant fibrosis. Several independent risk factors like large waist circumference, hypertriglyceridemia, abnormal high-density lipoprotein and diabetes are associated with significant MAFLD fibrosis. Light alcohol consumption is associated with increase incidence of significant liver fibrosis.