The NAFLD‐MAFLD debate: Eminence vs evidence

Abstract

Debates are inevitable in science and could be a powerful tool for addressing controversial topics as it promotes critical thinking and inspires individuals to consider alternate viewpoints. However, debates can help only to identify the issues that need to be clarified to address this question, but it can never help resolve the controversy itself. In the era of evidence‐based medicine, the need for an evidence‐based debate is mandatory. Polarising opinions and major debate have recently arisen in hepatology on the nomenclature and diagnostic criteria for fatty liver disease associated with metabolic dysfunction (non alcoholic fatty liver disease [NAFLD]‐metabolic (dysfunction) associated fatty liver disease [MAFLD] debate). The aim of this viewpoint is to suggest a way to settle the debate through evidence. Descriptive review using PubMed to identify literature on the evidence and eminence‐based medicine and studies comparing MAFLD and NAFLD criteria. The emerging studies comparing the performance of diagnostic criteria of NAFLD and MAFLD represent the dawn of a new era for reframing the ongoing debate by acquisition of the mandatory evidence that will both resolve the debate and lead to novel avenues of research. In conclusion, the time has come to hold debate and focus on gathering and building the evidence to settle it. It does not matter who wins the debate and once there is robust evidence, we should all follow it wherever it leads.

Re: Fouad Y, et al. The NAFLD‐MAFLD debate: Eminence versus evidence. Liver Int. 2020 Nov 21. doi: 10.1111/liv.14739

“…We read with interest the article published by Fouad et al regarding the renaming of NAFLD to Metabolic (Dysfunction) Associated Fatty Liver Disease or (MAFLD) and a way to settle this debate through evidence. 1 We agree with the authors that fueling this debate is not productive. That said there are some concepts that are worth mentioning.…”

NAFLD and MAFLD as emerging causes of HCC: A populational study

“… [26] , [27] , [28] However, this change remains controversial and its consequences, notably in the context of complications such as HCC, remain unclear. [29] , [30] , [31] To assess the potential role of MAFLD diagnosis in the context of HCC we compared characteristics of patients with MAFLD across subgroups. We found that a number of characteristics of patients with MAFLD-HCC (excluding NAFLD) were distinct from NAFLD and non-MAFLD.…”

Change from NAFLD to MAFLD increases the awareness of fatty liver disease in primary care physicians and specialists

“…The recent landmark articles by Eslam et al 1,2 have attracted substantial attention from various stakeholders. [3][4][5][6][7][8][9] although concerns have been raised that such a change may lead to confusion, particularly among non-hepatologists. 10 To better assess physician awareness, perception of disease severity, patterns of practice for the diagnosis and management of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), and to determine the impact of the proposed change in nomenclature, we undertook a national faceto-face survey from November 20, 2020 to December 20, 2020.…”