New criteria for metabolic dysfunction-associated fatty liver disease: advantage or question? Review

Abstract

The impact of fatty liver disease on public health and the economics has raised an increased interest in studying this disease. In the year 2020, experts of an international consensus group proposed to rename non‑alcoholic fatty liver disease (NAFLD) to the metabolic dysfunction‑associated fatty liver disease (MAFLD), and to change the diagnostic criteria for the fatty liver disease, because they did not correspond to the recent concepts. The previous name of NAFLD did not fully reflect the pathogenesis of the disease, in which excessive attention was paid to alcohol, and important metabolic risk factors that significantly affect the course of the disease were underestimated. This transition to MAFLD may be appropriate in terms of clinical data, determination of liver steatosis, separation of patients with different MAFLD phenotypes. The new diagnostic criteria for MAFLD are practical, easy to use, and superior to the existing NAFLD criteria for identifying patients at increased risk of developing progressive liver disease. They include evidence of hepatic steatosis, as well as the presence of at least one of three additional criteria: overweight/obesity, type 2 diabetes mellitus, and other metabolic disorders. The limitations of the new criteria for MAFLD include the absence of the concept of non‑alcoholic steatohepatitis, as well as the exclusion from the criteria of MAFLD of subjects with NAFLD without metabolic disorders, who are not diagnosed, and their potential risk may be the cause of future concomitant diseases and complications. However, among the expert society, it was not possible to reach a broad comprehensive understanding regarding the terminology and views on the development of the MAFLD. Debate continues regarding nomenclature and diagnostic criteria for fatty liver disease associated with metabolic dysfunction. Further cohort‑controlled studies based on evidence‑based medicine are needed to resolve controversial issues and to reach a consensus regarding MAFLD. Following up on the disease course and the evolution of medical terms can improve the understanding of the pathophysiology of liver diseases and create a new concept of fatty liver disease. Coordination of views of international experts in the field of the study of MAFLD will have a decisive role in the promotion of clinical practice and research.