From Nonalcoholic Fatty Liver Disease (NAFLD) to Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)—New Terminology in Pediatric Patients as a Step in Good Scientific Direction?

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, which predispose to more serious hepatic conditions. It ranges from simple liver steatosis to nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis, and even end-stage liver disease. Since obesity became one of the most important health concerns wordwide, a considerable increase in the prevalance of NAFLD and other metabolic implications has been observed, both in adults and children. Due to the coexistence of visceral obesity, insulin resistance, dyslipidemia, NAFLD is considered to be the hepatic manifestation of metabolic syndrome (MetS). These relationships between NAFLD and MetS led to the set up in adults of a new term combining both of these conditions, called metabolic dysfunction-associated fatty liver disease (MAFLD). Based on these findings, we propose a set of criteria, which may be useful to diagnose MAFLD in children and adolescents.

Non-Alcoholic Fatty Liver Disease in Children

“…The diagnostic criteria for NAFLD/MAFLD in children, in whom liver steatosis has been diagnosed by biomarkers, imaging, or liver biopsy, are [ 8 , 26 ]: Overweight (body mass index between 85th and 95th percentile) or obesity (body mass index more than 95th percentile), or abdominal obesity (waist circumference of ≥90th percentile for age and gender) or; Fasting plasma glucose of >100 mg/dL (5.6 mmol/L) or known diabetes mellitus type 2 or; In lean children, the presence of at least two metabolic risk disturbances: Elevated triglycerides ≥150 mg/dL (≥1.7 mmol/L); HDL-cholesterol <40 mg/dL (<1.03 mmol/L); Systolic blood pressure ≥130 or diastolic blood pressure ≥85 mmHg; Homeostatic model assessment for insulin resistance (HOMA-IR ≥ 2.5); High-sensitivity C-reactive protein >2 mg/L. …”

“…An additional condition is that other causes of fatty liver, such as inborn metabolic diseases, autoimmune and infectious causes are ruled out regardless of obesity or other risk factors for NAFLD [ 6 , 8 , 26 , 27 ].…”

“…A more appropriate term proposed especially for young children is pediatric fatty liver disease (PeFLD) [ 6 ]. The change in terminology is additionally justified by the recently published review in which the criteria for diagnosis in adolescents are also proposed [ 8 ]. As there is not yet a wide international acceptance of this meaningful terminological change, we decided to keep the term NAFLD for the purpose of this review, as it is still mostly used.…”

Editorial: International Consensus Recommendations to Replace the Terminology of Non-Alcoholic Fatty Liver Disease (NAFLD) with Metabolic-Associated Fatty Liver Disease (MAFLD)

“…According to the IDF consensus, metabolic syndrome should not be diagnosed in children below the age of 10 years, and the adult criteria should be used for patients older than 16 years [ 44 ]. In this context, Flisiak-Jackiewicz and colleagues have proposed pediatric diagnostic criteria for MAFLD in children aged 10–16 years, based on the presence of hepatic steatosis and either abdominal obesity (waist circumference ≥90 th percentile adjusted for age and gender) or fasting blood glucose >100 mg/dl, or known T2DM, or at least two metabolic risk factors in lean patients [ 45 ].…”

NAFLD-Related Hepatocarcinoma: The Malignant Side of Metabolic Syndrome

“…The relationship between NAFLD and metabolic dysfunctions has recently led to the new term 'MAFLD' (metabolic associated fatty liver disease), that underlines the coexistence of hepatic steatosis and metabolic dysfunctions [9]. Diagnostic criteria of MAFLD are based on a histological, radiological or laboratory evidence of liver fat accumulation (hepatic steatosis) in both young and adult patients of at least 16 years old, in addition to one of the following criteria: overweight/obesity, type 2 diabetes mellitus or evidence of metabolic dysregulation [10,11].…”