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      MAFLD: How is it different from NAFLD?

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          Abstract

          “Metabolic dysfunction-associated fatty liver disease (MAFLD)” is the term suggested in 2020 to refer to fatty liver disease related to systemic metabolic dysregulation. The name change from nonalcoholic fatty liver disease (NAFLD) to MAFLD comes with a simple set of criteria to enable easy diagnosis at the bedside for the general medical community, including primary care physicians. Since the introduction of the term, there have been key areas in which the superiority of MAFLD over the traditional NAFLD terminology has been demonstrated, including for the risk of liver and extrahepatic mortality, disease associations, and for identifying high-risk individuals. Additionally, MAFLD has been adopted by a number of leading pan-national and national societies due to its concise diagnostic criterion, removal of the requirement to exclude concomitant liver diseases, and reduction in the stigma associated with this condition. The current article explores the differences between MAFLD and NAFLD diagnosis, areas of benefit, some potential limitations, and how the MAFLD terminology has opened up new fields of research.

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          Most cited references62

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

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            A new definition for metabolic associated fatty liver disease: an international expert consensus statement

            The exclusion of other chronic liver diseases including "excess" alcohol intake has until now been necessary to establish a diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). However, given our current understanding of the pathogenesis of MAFLD and its rising prevalence, "positive criteria" to diagnose the disease are required. In this work, a panel of international experts from 22 countries propose a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and is independent of other liver diseases. The criteria are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose that disease assessment and stratification of severity should extend beyond a simple dichotomous classification to steatohepatitis vs. non-steatohepatitis. The group also suggests a set of criteria to define MAFLD-associated cirrhosis and proposes a conceptual framework to consider other causes of fatty liver disease. Finally, we bring clarity to the distinction between diagnostic criteria and inclusion criteria for research studies and clinical trials. Reaching consensus on the criteria for MAFLD will help unify the terminology (e.g. for ICD-coding), enhance the legitimacy of clinical practice and clinical trials, improve clinical care and move the clinical and scientific field of liver research forward.
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              Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.

              Nonalcoholic steatohepatitis is a poorly understood and hitherto unnamed liver disease that histologically mimics alcoholic hepatitis and that also may progress to cirrhosis. Described here are findings in 20 patients with nonalcoholic steatohepatitis of unknown cause. The biopsy specimens were characterized by the presence of striking fatty changes with evidence of lobular hepatitis, focal necroses with mixed inflammatory infiltrates, and, in most instances, Mallory bodies; Evidence of fibrosis was found in most specimens, and cirrhosis was diagnosed in biopsy tissue from three patients. The disease was more common in women. Most patients were moderately obese, and many had obesity-associated diseases, such as diabetes mellitus and cholelithiasis. Presence of hepatomegaly and mild abnormalities of liver function were common clinical findings. Currently, we know of no effective therapy.
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                Author and article information

                Journal
                Clin Mol Hepatol
                Clin Mol Hepatol
                CMH
                Clinical and Molecular Hepatology
                The Korean Association for the Study of the Liver
                2287-2728
                2287-285X
                February 2023
                29 November 2022
                : 29
                : Suppl
                : S17-S31
                Affiliations
                [1 ]Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, Australia
                [2 ]Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
                [3 ]Department of Gastroenterology and Hepatology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
                [4 ]Department of Gastroenterology and Hepatology, University of New South Wales, Sydney, NSW, Australia
                [5 ]MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
                [6 ]Wenzhou Key Laboratory of Hepatology, Wenzhou, China
                [7 ]Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
                [8 ]Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
                Author notes
                Corresponding author : Cameron Gofton Department of Gastroenterology and Hepatology, Royal North Shore Hospital, 1 Reserve Road, St Leonards, NSW 2065, Australia Tel: +61294632463, Fax: +61294632041, E-mail: Cameron.Gofton@ 123456health.nsw.gov.au

                Editor: Byoung Kuk Jang, Keimyung University School of Medicine, Korea

                Author information
                http://orcid.org/0000-0002-0913-7180
                Article
                cmh-2022-0367
                10.3350/cmh.2022.0367
                10029949
                36443926
                26280a9a-10c8-4e36-815e-8021661d80e8
                Copyright © 2023 by The Korean Association for the Study of the Liver

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 November 2022
                : 22 November 2022
                : 24 November 2022
                Categories
                Review

                Gastroenterology & Hepatology
                mafld,nafld,mafld vs. nafld
                Gastroenterology & Hepatology
                mafld, nafld, mafld vs. nafld

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