Renaming NAFLD to MAFLD: Advantages and Potential Changes in Diagnosis, Pathophysiology, Treatment, and Management

Abstract

In recent years, with the increasing incidence of obesity and other metabolic diseases, the prevalence of non-alcoholic fatty liver disease (NAFLD) has increased and it has become a major health problem affecting more than one quarter of the world's population. Recently, experts reached a consensus that NAFLD does not reflect the current knowledge, and metabolic dysfunction-associated fatty liver disease (MAFLD) was suggested as a more appropriate term. MAFLD is not just a simple renaming of NAFLD. The definition of MAFLD allows a patient to have dual (or more) etiologies for their liver disease, which will help to exclude more heterogeneous patients. In this review, we introduce the significant differences between the definitions of NAFLD and MAFLD. In addition, we also describe the advantages of the term MAFLD in the pathophysiology, therapy, and patient management.

Mitochondrial dysfunction: A promising therapeutic target for liver diseases

“…Hepatotoxins (drugs, alcohol consumption, viral or bacterial infection, and lipid deposition) or autoimmune response can induce acute liver injury and chronic liver diseases such as viral hepatitis, drug-induced liver injury, autoimmune hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease (NAFLD). 1 Hepatic fibrosis is a common complication of almost all types of hepatopathies, and if left untreated, liver fibrosis may eventually progress to cirrhosis, liver failure, and hepatocellular carcinoma (HCC). 2 , 3 , 4 Fibrosis is a dynamic process that can be prevented or reverted by eliminating pathogenic factors or carrying out appropriate therapeutic interventions, such as with antiviral drugs that delay the progression of virus-associated hepatic fibrosis.…”

Association of Diabetes Mellitus with All-Cause and Cause-Specific Mortality among Patients with Metabolic-Dysfunction-Associated Fatty Liver Disease: A Longitudinal Cohort Study

“…MAFLD includes a spectrum of liver histological progressions ranging from simple steatosis to varying degrees of fibrosis with infiltration of inflammatory cells. Compared with NAFLD patients, MAFLD patients are more at risk of having broad metabolic traits and higher fibrosis levels [ 3 , 4 ]. Like other chronic liver diseases, it can develop into cirrhosis if fibrosis progresses [ 5 ].…”

Valuing the Prevention and Treatment of Liver Disease to Promote Human Wellbeing

“…In 2020, the consensus of an international expert group recommended changing the name of NAFLD to MAFLD. 10 The new diagnostic criteria are based on histological (liver biopsy), radiographic, and blood biomarker evidence of hepatic fat accumulation (hepatocellular steatosis) in combination with one of the following conditions; overweight, obesity, type 2 diabetes, or metabolic dysfunction. 11 Diagnosis is based on the presence of metabolic dysfunction, which is a positive diagnostic criterion, not an exclusion-based diagnosis, and absence of excessive alcohol consumption is no longer a diagnostic criterion.…”

“…However, this definition lacks consideration of disease heterogeneity and hinders the study of precision therapy. In 2020, the consensus of an international expert group recommended changing the name of NAFLD to MAFLD 10 . The new diagnostic criteria are based on histological (liver biopsy), radiographic, and blood biomarker evidence of hepatic fat accumulation (hepatocellular steatosis) in combination with one of the following conditions; overweight, obesity, type 2 diabetes, or metabolic dysfunction 11 .…”