MAFLD - a new approach to fatty liver disease
DOI:
https://doi.org/10.12775/JEHS.2025.80.60039Keywords
MAFLD, NAFLD, steatohepatitis, diagnostic criteria, obesity, liver diseases, metabolic, fibrosisAbstract
Fatty liver disease associated with metabolic dysfunction (MAFLD) is a term introduced in 2020 to refer to fatty liver disease associated with systemic metabolic dysregulation. The name change from nonalcoholic fatty liver disease (NAFLD) to fatty liver disease associated with metabolic dysfunction (MAFLD) was proposed to focus on the bidirectional interaction between fatty liver disease and metabolic changes and to emphasize the need to evaluate fatty liver disease independently of alcohol consumption and other comorbid causes of liver disease. Fatty liver disease associated with metabolic dysfunction (MAFLD) affects approximately 25% of the general population and more than 50% of patients with metabolic disorders. This new concept of MAFLD may have a broad impact on patients, physicians, healthcare professionals, and various stakeholders regarding fatty liver disease. In this way, MAFLD may influence clinical practice and increase awareness regarding fatty liver disease. This paper identifies differences between the MAFLD and NAFLD diagnoses, areas of benefit, potential limitations, and how the MAFLD terminology has opened up new areas of research.
References
1. Gofton C, Upendran Y, Zheng MH, George J. MAFLD: How is it different from NAFLD? Clin Mol Hepatol. 2023 Feb;29(Suppl):S17-S31. doi: 10.3350/cmh.2022.0367.
2. Semmler G, Wernly S, Bachmayer S, Leitner I, Wernly B, Egger M, et al. Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)-Rather a Bystander Than a Driver of Mortality. J Clin Endocrinol Metab 2021;106:2670-2677.
3. Kawaguchi T, Tsutsumi T, Nakano D, Torimura T. MAFLD: Renovation of clinical practice and disease awareness of fatty liver. Hepatol Res. 2022 May;52(5):422-432. doi: 10.1111/hepr.13706.
4. Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int 2017;37 Suppl 1:81-84.
5. Demirtas CO, Yilmaz Y. Metabolic-associated fatty liver disease: Time to integrate ground-breaking new terminology to our clinical practice? Hepatol Forum 2020;1:79-81.
6. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunctionassociated fatty liver disease: An international expert consensus statement. J Hepatol 2020;73:202-209.
7. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67:328-357.
8. Kawaguchi T, Tsutsumi T, Nakano D, Eslam M, George J, Torimura T. MAFLD enhances clinical practice for liver disease in the Asia-Pacific region. Clin Mol Hepatol 2022;28:150-163.Dsd
9. Wang X, Xie Q. Metabolic Dysfunction-associated Fatty Liver Disease (MAFLD) and Viral Hepatitis. J Clin Transl Hepatol 2022;10:128-133.
10. Younossi ZM, Paik JM, Al Shabeeb R, Golabi P, Younossi I, Henry L. Are there outcome differences between NAFLD and metabolicassociated fatty liver disease? Hepatology 2022;76:1423-1437.
11. Liu J, Ayada I, Zhang X i wsp. Estimating global prevalence of metabolic dysfunction-associated fatty liver disease in overweight or obese adults. Clin Gastroenterol Hepatol 2022; 20: e573-e582.
12. Wong RJ, Cheung R. Trends in the prevalence of metabolic dysfunction-associated fatty liver disease in the United States, 2011-2018. Clin Gastroenterol Hepatol 2022; 20: e610-e613.
13. Chen YL, Li H, Li S i wsp. Prevalence of and risk factors for metabolic associated fatty liver disease in an urban population in China: a cross-sectional comparative study. BMC Gastroenterol 2021; 21: 212.
14. Lee H, Lim TS, Kim SU, Kim HC. Long-term cardiovascular outcomes differ across metabolic dysfunction-associated fatty liver disease subtypes among middle-aged population. Hepatol Int 2022; 16: 1308-1317.
15. Siddiqui, M.S., Harrison, S.A., Abdelmalek, M.F. Case definitions for inclusion and analysis of endpoints in clinical trials for nonalcoholic steatohepatitis through the lens of regulatory science. Hepatology. 2018; 67:2001-2012
16. European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016; 64:1388-1402
17. Wong, V.W., Chan, W.K., Chitturi, S. Asia-pacific working party on non-alcoholic fatty liver disease guidelines 2017-Part 1: definition, risk factors and assessment. J Gastroenterol Hepatol. 2018; 33:70-85
18. Chalasani, N., Younossi, Z., Lavine, J.E. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018; 67:328-357
19. Lin S, Huang J, Wang M, Kumar R, Liu Y, Liu S, Wu Y, Wang X, Zhu Y. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int. 2020 Sep;40(9):2082-2089. doi: 10.1111/liv.14548. Epub 2020 Jul 26. PMID: 32478487.
20. Lim GEH, Tang A, Ng CH, Chin YH, Lim WH, Tan DJH, et al. An observational data meta-analysis on the differences in prevalence and risk factors between MAFLD vs NAFLD. Clin Gastroenterol Hepatol 2021 Dec 4;doi: 10.1016/j.cgh.2021.11.038.
21. Yamamura S, Eslam M, Kawaguchi T, Tsutsumi T, Nakano D, Yoshinaga S, et al. MAFLD identifies patients with significant hepatic fibrosis better than NAFLD. Liver Int 2020;40:3018-3030.
22. Zeng J, Qin L, Jin Q, Yang RX, Ning G, Su Q, et al. Prevalence and characteristics of MAFLD in Chinese adults aged 40 years or older: A community-based study. Hepatobiliary Pancreat Dis Int 2022;21:154-161.
23. Bergqvist CJ, Skoien R, Horsfall L, Clouston AD, Jonsson JR, Powell EE. Awareness and opinions of non-alcoholic fatty liver disease by hospital specialists. Intern Med J 2013;43:247-253.
24. Wang X, Xie Q. Metabolic Dysfunction-associated Fatty Liver Disease (MAFLD) and Viral Hepatitis. J Clin Transl Hepatol 2022;10:128-133.
25. Xue J, Wang QX, Xiao HM, Shi MJ, Xie YB, Li S, et al. Impact of metabolic dysfunction associated fatty liver disease on the prognosis of patients with Hepatitis B Virus-related hepatocellular carcinoma based on propensity score matching analysis. Cancer Manag Res 2022;14:2193-2202.
26. Zheng KI, Sun DQ, Jin Y, Zhu PW, Zheng MH. Clinical utility of the MAFLD definition. J Hepatol 2021;74:989-991.
27. Zhang HJ, Wang YY, Chen C, et al. Cardiovascular and renal burdens of metabolic associated fatty liver disease from serial US national surveys, 1999–2016. Chin Med J 2021; 134: 1593–1601.
28. Lin S, Huang J, Wang M, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liv Int 2020; 40: 2082–2089.
29. Yamamura S, Eslam M, Kawaguchi T, et al. MAFLD identifies patients with significant hepatic fibrosis better than NAFLD. Liv Int 2020; 40: 3018–3030.
30. Huang S-C, Su H-J, Kao J-H, et al. Clinical and histologic features of patients with biopsy-proven metabolic dysfunction-associated fatty liver disease. Gut Liver 2021; 15: 451–458.
31. Miao L, Yang L, Guo LS, Shi QQ, Zhou TF, Chen Y, et al. Metabolic dysfunction-associated fatty liver disease is associated with greater impairment of lung function than nonalcoholic fatty liver disease. J Clin Transl Hepatol 2022;10:230-237.
32. Ayada I, van Kleef LA, Alferink LJM, Li P, de Knegt RJ, Pan Q. Systematically comparing epidemiological and clinical features of MAFLD and NAFLD by meta-analysis: Focusing on the nonoverlap groups. Liver Int 2022;42:277-287.
33. Shiha G, Korenjak M, Eskridge W, Casanovas T, Velez-Moller P, Högström S, et al. Redefining fatty liver disease: an international patient perspective. Lancet Gastroenterol Hepatol 2021;6:73-79.
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Copyright (c) 2025 Borys Łozowski, Kinga Brzuszkiewcz-Łozowska, Monika Kułaga, Anna Kasprzak, Monika Grzybek, Diana Mazur-Lesińska, Barbara Szostak, Sylwia Wielgosz-Biała, Krzysztof Tyszkiewicz, Barbara Wilczyńska, Małgorzata Kasprzak
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