What's in a name? Renaming ‘NAFLD’ to ‘MAFLD’

Abstract

In medicine, language matters and the words used to name and describe a disease can have a profound impact on patients and their families. Over the last two decades, many criticisms have been voiced about the nomenclature and definition of non-alcoholic fatty liver disease (NAFLD) in regards not only to the prominent role that alcohol plays in the definition but also on the negative impacts of the nomenclature including trivialization, stigmatization and less consideration of the disease in health policy. Recently, a consensus of international experts proposed that the disease acronym be changed from NAFLD to metabolic (dysfunction) associated fatty liver disease or 'MAFLD'. This change goes far beyond a mere semantic revision and may be the first step that catalyses the process to better conceptualize the disease for health promotion, patient orientation, case identification, ongoing clinical trials and for health services delivery. Here we review the history of, and definitions of MAFLD in the context of advancing our understanding of the pathogenesis of the disease. We also address the reasons, signals, promises, challenges and the way going forward from the name change from various stakeholder perspectives. K E Y W O R D S MAFLD, metabolic, nomenclature | 1255 FOUAD et Al.

History of Nonalcoholic Fatty Liver Disease

“…Formerly named nonalcoholic fatty liver disease (NAFLD), the spectrum of fatty liver disorders not resulting from alcohol abuse, viral, autoimmune, drug-induced and genetic etiologies, has recently been renamed metabolic (dysfunction) associated fatty liver disease (MAFLD) [1]. In agreement with a consistent line of opinions, this novel nomenclature correctly points out the "positive" determinants of the disease, namely the close association with metabolic disorders, rather than defining it for what it is not (i.e., nonalcoholic) [2]. Table 1 [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] lists some of the definitions that have either been proposed or used to designate NAFLD/MAFLD over time.…”

MAFLD criteria overlooks a number of patients with severe steatosis: Is it clinically relevant?

“…1 Unlike non-alcoholic fatter liver disease (NAFLD), 2 the diagnosis of MAFLD requires the presence any of the following 3 metabolic risks, including overweight/ obesity, presence of diabetes mellitus, and evidence of metabolic dysregulation. 1,3 However, there are patients that have hepatic steatosis but no metabolic risk, who thus do not meet the diagnostic criteria of MAFLD. The clinical features and the management of this specific group of patients remain unclear.…”

NAFLD and liver transplantation: Disease burden, current management and future challenges

“…1 Recently the term metabolic dysfunctionassociated fatty liver disease (MAFLD) has been proposed to better describe liver disease associated with metabolic dysfunction, 2 leading to discussions within the scientific community regarding potential consequent changes in diagnosis, clinical management and drug development. [3][4][5] Until now, NAFLD has been diagnosed by the presence of hepatic steatosis on radiological imaging or biopsy, after ruling out all other reasonable causes (e.g. alcohol consumption).…”