☆ 4.5 Review

MAFLD: How is it different from NAFLD?

CLINICAL AND MOLECULAR HEPATOLOGY (2023)

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Review Gastroenterology & Hepatology

An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD

Grace En Hui Lim et al.

Summary: The redefinition of nonalcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) can have significant implications for patient care and the field overall. This study aimed to compare the differences in the natural history of NAFLD and MAFLD.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2023)

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Review Gastroenterology & Hepatology

Comparative Burden of Metabolic Dysfunction in Lean NAFLD vs Non-lean NAFLD-A Systematic Review and Meta-analysis

Ansel Tang et al.

Summary: Nonalcoholic fatty liver disease (NAFLD) is commonly associated with obesity, but there is a subtype called lean NAFLD that occurs without obesity. However, there is a debate about whether NAFLD should be redefined to focus on obesity and metabolic dysfunction. This analysis reveals that lean individuals with NAFLD have significantly less metabolic dysfunction compared to obese and overweight individuals with NAFLD.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2023)

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Article Gastroenterology & Hepatology

Nonalcoholic Fatty Liver Disease Without Metabolic-associated Fatty Liver Disease and the Risk of Metabolic Syndrome

Dong Hyun Sinn et al.

Summary: The clinical implications of nonalcoholic fatty liver disease (NAFLD) in subjects who fulfill the diagnostic criteria of metabolic (dysfunction)-associated fatty liver disease (MAFLD) are unknown.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2023)

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Article Gastroenterology & Hepatology

Type 2 diabetes mellitus in metabolic-associated fatty liver disease vs. type 2 diabetes mellitus non-alcoholic fatty liver disease: a longitudinal cohort analysis

Mark Muthiah et al.

Summary: This study analyzed data from the United States NHANES and found that the new definition of MAFLD increased the diagnosis of fatty liver in patients with T2DM by 68.89%. Patients classified as MAFLD(+)/NAFLD(-) had a higher risk of adverse cardiovascular events, advanced fibrosis, and mortality compared to MAFLD(+)/NAFLD(+) patients. Viral hepatitis significantly increased the risk of advanced fibrosis and all-cause mortality in MAFLD(+)/NAFLD(-) patients.

ANNALS OF HEPATOLOGY (2023)

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Review Cell Biology

Why does obesity cause diabetes?

Samuel Klein et al.

Summary: The accumulation of excessive body fat can lead to type 2 diabetes, and the risk of type 2 diabetes increases with an increase in body mass index. The global increase in obesity has therefore resulted in a corresponding increase in the prevalence of type 2 diabetes. The mechanisms linking obesity and type 2 diabetes involve complex changes in b cell function, adipose tissue biology, and multi-organ insulin resistance, which can be improved or even normalized through weight loss.

CELL METABOLISM (2022)

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Article Gastroenterology & Hepatology

Metabolic Dysfunction-Associated Fatty Liver Disease Predicts Long-term Mortality and Cardiovascular Disease

Joon Ho Moon et al.

Summary: MAFLD independently increased overall mortality, while NAFLD did not. MAFLD also predicted CVD, but this association lost statistical significance with further adjustments. Metabolic dysfunction contributed to increased mortality and CVD risk among subjects with MAFLD.

GUT AND LIVER (2022)

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Article Gastroenterology & Hepatology

Prevalence and characteristics of MAFLD in Chinese adults aged 40 years or older: A community-based study

Jing Zeng et al.

Hepatobiliary & Pancreatic Diseases International (2022)

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Article Gastroenterology & Hepatology

Impact of renaming NAFLD to MAFLD in an Australian regional cohort: Results from a prospective population-based study

William Kemp et al.

Summary: The study found a higher prevalence of metabolic-associated fatty liver disease (MAFLD) compared to non-alcoholic fatty liver disease (NAFLD) in a well-defined cohort, with the increased prevalence of MAFLD primarily driven by the presence of dual etiologies of liver disease. All participants classified as NAFLD also met the new definition of MAFLD.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY (2022)

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Article Gastroenterology & Hepatology

Systematically comparing epidemiological and clinical features of MAFLD and NAFLD by meta-analysis: Focusing on the non-overlap groups

Ibrahim Ayada et al.

Summary: Metabolic dysfunction associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD) have high prevalence in the general population, with considerable overlap between them. However, compared to NAFLD, using the MAFLD criteria can identify more individuals with liver damage.

LIVER INTERNATIONAL (2022)

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Article Endocrinology & Metabolism

Fatty liver with metabolic disorder, such as metabolic dysfunction-associated fatty liver disease, indicates high risk for developing diabetes mellitus

Teruki Miyake et al.

Summary: The study found that patients with fatty liver disease associated with metabolic disorders such as MAFLD are more likely to develop diabetes mellitus. Additionally, patients with fatty liver disease complicated by overweight/obesity or prediabetes are at increased risk of onset of diabetes mellitus.

JOURNAL OF DIABETES INVESTIGATION (2022)

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Review Gastroenterology & Hepatology

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

Takumi Kawaguchi et al.

Summary: Fatty liver has become a major cause of liver disease in the Asia-Pacific region. It is frequently observed in lean/normal-weight individuals and often coexists with viral hepatitis. An international expert panel has proposed a new definition, metabolic dysfunction-associated fatty liver disease (MAFLD), which is more suitable for the region due to its inclusion of lean/normal-weight individuals and independence from concomitant liver diseases.

CLINICAL AND MOLECULAR HEPATOLOGY (2022)

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Review Gastroenterology & Hepatology

MAFLD: Renovation of clinical practice and disease awareness of fatty liver

Takumi Kawaguchi et al.

Summary: MAFLD is a new definition of fatty liver that includes metabolic dysfunctions and is independent of alcohol intake and other causes of liver disease. This concept may have a significant impact on clinical practice and disease awareness.

HEPATOLOGY RESEARCH (2022)

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Article Gastroenterology & Hepatology

Are there outcome differences between NAFLD and metabolic-associated fatty liver disease?

Zobair M. Younossi et al.

Summary: This study compared the long-term outcomes of NAFLD and MAFLD and found that they have similar clinical profiles and long-term prognosis. Insulin resistance is a predictor of liver mortality in NAFLD, while alcohol-associated liver disease (ALD) is the primary driver of mortality in MAFLD.

HEPATOLOGY (2022)

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Letter Gastroenterology & Hepatology

The International Society of Tropical Paediatrics (ISTP) endorses the redefinition of fatty liver disease

Mortada El-Shabrawi et al.

JOURNAL OF HEPATOLOGY (2022)

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Article Gastroenterology & Hepatology

Ethyl glucuronide in hair detects a high rate of harmful alcohol consumption in presumed non-alcoholic fatty liver disease

Katharina Staufer et al.

Summary: This study investigated alcohol consumption in patients with presumed NAFLD and ALD, using novel objective alcohol markers. The results showed that approximately 28.6% of presumed NAFLD patients and 25% of MAFLD patients are at risk of alcohol-related liver damage.

JOURNAL OF HEPATOLOGY (2022)

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Article Multidisciplinary Sciences

A significant risk of metabolic dysfunction-associated fatty liver disease plus diabetes on subclinical atherosclerosis

Rieko Bessho et al.

Summary: This study investigated the association between subclinical atherosclerosis and metabolic dysfunction-associated fatty liver disease (MAFLD) or non-alcoholic fatty liver disease (NAFLD), as well as the synergistic effect of diabetes mellitus (DM) and MAFLD on subclinical atherosclerosis. The results showed that MAFLD was significantly associated with subclinical atherosclerosis in the general population, and DM-MAFLD could be a significant risk factor for cardiovascular disease through insulin resistance and low-grade inflammation.

PLOS ONE (2022)

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Review Gastroenterology & Hepatology

Nonalcoholic fatty liver disease versus metabolic-associated fatty liver disease: Prevalence, outcomes and implications of a change in name

Cheng Han Ng et al.

Summary: Nonalcoholic fatty liver disease (NAFLD) affects a large percentage of the adult population worldwide. Recent studies suggest that renaming it to metabolic-associated fatty liver disease (MAFLD) may better reflect its underlying pathophysiology and highlight the higher prevalence of metabolic comorbidities and mortality rates compared to NAFLD.

CLINICAL AND MOLECULAR HEPATOLOGY (2022)

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Article Gastroenterology & Hepatology

A new risk stratification strategy for fatty liver disease by incorporating MAFLD and fibrosis score in a large US population

Ya-Cong Zhang et al.

Summary: This study demonstrated the validity of MAFLD subtype and fibrosis score in stratifying the risk of FLD patients using a representative sample of the US population. These findings can guide the determination of surveillance options for FLD patients.

HEPATOLOGY INTERNATIONAL (2022)

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Review Medicine, General & Internal

Current treatment of non-alcoholic fatty liver disease

Rafael Paternostro et al.

Summary: Non-alcoholic fatty liver disease (NAFLD) is a liver disease with various pathologies. In addition to lifestyle changes and a few specific medications, there are new treatment options being studied. Treating complications of end-stage liver disease caused by non-alcoholic steatohepatitis (NASH) is important for the treatment of the complete clinical spectrum of NAFLD.

JOURNAL OF INTERNAL MEDICINE (2022)

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Article Biochemistry & Molecular Biology

Microbiome-derived ethanol in nonalcoholic fatty liver disease

Abraham S. Meijnikman et al.

Summary: This study found that microbial ethanol might contribute to pathogenesis in some patients with nonalcoholic fatty liver disease. The research suggests that microbial ethanol could be considered in the pathogenesis of this highly prevalent liver disease.

NATURE MEDICINE (2022)

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Article Gastroenterology & Hepatology

The NAFLD-MAFLD debate through the lens of the Arab world

Mina Tharwat et al.

Summary: Fatty liver disease related to metabolic dysfunction is the most common liver disease globally. In Arab countries, where obesity and related comorbidities are prevalent, but alcohol consumption is low, there is a need to redefine the disease to enhance understanding, treatment, and quality of life for patients.

SAUDI JOURNAL OF GASTROENTEROLOGY (2022)

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Article Gastroenterology & Hepatology

Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study

Hokyou Lee et al.

Summary: This study found a high prevalence of fatty liver disease (FLD) among middle-aged Korean adults, with MAFLD having a significantly higher prevalence than NAFLD. Both NAFLD and MAFLD were associated with an increased risk of cardiovascular disease (CVD).

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2021)

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Article Gastroenterology & Hepatology

Differential Clinical Characteristics and Mortality Outcomes in Persons With NAFLD and/or MAFLD

Vy H. Nguyen et al.

Summary: The study found that individuals meeting the criteria for MAFLD had more comorbidities and worse prognosis compared to those with NAFLD only. Non-NAFLD MAFLD participants had the highest cumulative incidence of all-cause mortality, followed by NAFLD-MAFLD and non-MAFLD NAFLD participants. The MAFLD criteria should be considered in the general population to identify high-risk groups for early interventions.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2021)

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Letter Gastroenterology & Hepatology

Clinical utility of the MAFLD definition

Kenneth I. Zheng et al.

JOURNAL OF HEPATOLOGY (2021)

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Letter Gastroenterology & Hepatology

Capturing patient experience: A qualitative study of change from NAFLD to MAFLD real-time feedback

Shereen Abdel Alem et al.

JOURNAL OF HEPATOLOGY (2021)

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Review Gastroenterology & Hepatology

From NAFLD to MAFLD: Nurse and allied health perspective

Michelle Clayton et al.

Summary: Nurses and allied health practitioners have raised serious concerns about the existing nomenclature and diagnostic criteria, and they enthusiastically support the call to rename non-alcoholic fatty liver disease, believing it will have a positive impact on nurse-patient communication and ultimately improve patient care and quality of life.

LIVER INTERNATIONAL (2021)

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Article Gastroenterology & Hepatology

Does the risk of cardiovascular events differ between biopsy-proven NAFLD and MAFLD?

Gabriel Tayguara Silveira Guerreiro et al.

Summary: Patients with NAFLD and MAFLD have similar cardiovascular risk and rates of cardiovascular disease, while those with MAFLD and concurrent viral infection show significantly increased cardiovascular risk and rates of cardiovascular disease.

HEPATOLOGY INTERNATIONAL (2021)

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Article Endocrinology & Metabolism

MAFLD and risk of CKD

Dan-Qin Sun et al.

Summary: This study showed that patients with MAFLD have a higher risk of CKD compared to NAFLD patients, and the severity of MAFLD is associated with CKD and abnormal albuminuria.

METABOLISM-CLINICAL AND EXPERIMENTAL (2021)

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Article Multidisciplinary Sciences

Outcomes of NAFLD and MAFLD: Results from a community-based, prospective cohort study

Madunil Anuk Niriella et al.

Summary: This study compared the impact of NAFLD and MAFLD on health outcomes and found that the risks of new-onset metabolic traits and cardiovascular events were similar between the two during a 7-year follow-up. Individuals excluded by the NAFLD definition but captured by the MAFLD definition showed a higher risk of adverse outcomes compared to those excluded by the MAFLD definition but captured by the NAFLD definition.

PLOS ONE (2021)

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Article Endocrinology & Metabolism

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)-Rather a Bystander Than a Driver of Mortality

Georg Semmler et al.

Summary: The presence of MAFLD does not increase mortality in individuals aged 45 to 80 years. However, lean and overweight patients with MAFLD had worse prognosis compared to their non-MAFLD counterparts, driven primarily by age and metabolic comorbidities.

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM (2021)

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Article Gastroenterology & Hepatology

The Chinese Society of Hepatology position statement on the redefinition of fatty liver disease

Yuemin Nan et al.

Summary: Fatty liver disease associated with metabolic dysfunction is a growing concern in China with the highest incidence rate compared to European countries and the US. The proposal to change the name from NAFLD to MAFLD has received strong support in China, and it is expected to improve healthcare for patients and advance disease awareness, public health policy, and other outcomes related to MAFLD.

JOURNAL OF HEPATOLOGY (2021)

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Review Gastroenterology & Hepatology

From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

Seong Hee Kang et al.

Summary: The transition from NAFLD to MAFLD involves including FLD subjects with metabolic abnormalities in the criteria while excluding those without, leading to a focus on metabolic dysfunction in the MAFLD criteria. This may underestimate the prognostic value of hepatic steatosis, but could better identify subjects at higher risk of liver or cardiovascular outcomes.

CLINICAL AND MOLECULAR HEPATOLOGY (2021)

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Article Gastroenterology & Hepatology

Arabic Association for the Study of Diabetes and Metabolism (AASD) endorsing the MAFLD definition of fatty liver disease

Inass Shaltout et al.

JOURNAL OF HEPATOLOGY (2021)

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Article Medicine, General & Internal

NAFLD or MAFLD: Which Has Closer Association With All-Cause and Cause-Specific Mortality?-Results From NHANES III

Qi Huang et al.

Summary: The study found that participants with MAFLD or NAFLD were highly concordant, with MAFLD showing a greater overall mortality risk compared to NAFLD, but equal risk for cause-specific mortality. The new terminology excluded participants with lower mortality risk and included those with higher risk.

FRONTIERS IN MEDICINE (2021)

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Article Environmental Sciences

Open Issues in the Transition from NAFLD to MAFLD: The Experience of the Plinio Study

Francesco Baratta et al.

Summary: Applying the MAFLD criteria to a cohort of dysmetabolic patients with NAFLD led to a significant overlap between the NAFLD and MAFLD diagnoses, with specific subgroups such as lean NAFLD patients being excluded by the new MAFLD definition.

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH (2021)

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Article Endocrinology & Metabolism

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)-Rather a Bystander Than a Driver of Mortality

Georg Semmler et al.

Summary: In this single-center cohort study, the presence of MAFLD was not found to increase mortality among individuals aged 45 to 80. Factors such as body mass index (BMI) and metabolic comorbidities, particularly diabetes, were found to have a stronger impact on mortality rates.

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM (2021)

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Article Gastroenterology & Hepatology

Awareness of Nonalcoholic Fatty Liver Disease Is Increasing but Remains Very Low in a Representative US Cohort

Amandeep Singh et al.

DIGESTIVE DISEASES AND SCIENCES (2020)

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Article Gastroenterology & Hepatology

A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement

Mohammed Eslam et al.

JOURNAL OF HEPATOLOGY (2020)

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Article Gastroenterology & Hepatology

Comparison of MAFLD and NAFLD diagnostic criteria in real world

Su Lin et al.

LIVER INTERNATIONAL (2020)

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Article Gastroenterology & Hepatology

The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease

Mohammed Eslam et al.

HEPATOLOGY INTERNATIONAL (2020)

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Article Gastroenterology & Hepatology

MAFLD identifies patients with significant hepatic fibrosis better than NAFLD

Sakura Yamamura et al.

LIVER INTERNATIONAL (2020)

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Article Gastroenterology & Hepatology

Report on the AASLD/EASL Joint Workshop on Clinical Trial Endpoints in NAFLD

Mary E. Rinella et al.

HEPATOLOGY (2019)

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Article Health Care Sciences & Services

Low Awareness of Nonalcoholic Fatty Liver Disease in a Population-Based Cohort Sample: the CARDIA Study

Erin R. Cleveland et al.

JOURNAL OF GENERAL INTERNAL MEDICINE (2019)

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Article Gastroenterology & Hepatology

The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases

Naga Chalasani et al.

HEPATOLOGY (2018)

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Article Gastroenterology & Hepatology

EASL Clinical Practice Guidelines: Management of alcohol-related liver disease

Mark Thursz et al.

JOURNAL OF HEPATOLOGY (2018)

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Article Medicine, General & Internal

Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease

Myriam Alexander et al.

BMC MEDICINE (2018)

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Article Gastroenterology & Hepatology

The epidemiology of non-alcoholic fatty liver disease

Stefano Bellentani

LIVER INTERNATIONAL (2017)

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Article Endocrinology & Metabolism

EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease

OBESITY FACTS (2016)

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Article Medicine, General & Internal

Awareness and opinions of non-alcoholic fatty liver disease by hospital specialists

C. -J. Bergqvist et al.

INTERNAL MEDICINE JOURNAL (2013)

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Review Gastroenterology & Hepatology

From NAFLD in clinical practice to answers from guidelines

Fabio Nascimbeni et al.

JOURNAL OF HEPATOLOGY (2013)

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