Problems and Challenges Associated with Renaming Non-alcoholic Fatty Liver Disease to Metabolic Associated Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) has become the world's largest chronic liver disease in the 21st century, affecting 20%-30% of the world's population. As the epidemiology, etiology, and pathogenesis of NAFLD have been studied in-depth, it has been gradually recognized that most patients with NAFLD have one or more combined metabolic abnormalities known as metabolic syndrome. In 2020, the international expert group changed the name of NAFLD to metabolic-associated fatty liver disease (MAFLD) and proposed new diagnostic criteria for MAFLD and MAFLD-related liver cirrhosis, as well as the conceptual framework of other cause-related fatty liver diseases to avoid diagnosis based on the exclusion of other causes and better reflect its pathogenesis. However, there are still many ambiguities in the term, and changing the name does not address the unmet key needs in the field. The change from NAFLD to MAFLD was not just a change of definition. The problems and challenges are summarized as follows: epidemiology, children, rationality of "metabolism," diagnostic criteria, double/multiple causes, drug discovery, clinical trials, and awareness raising. Metabolic-associated fatty liver disease has complex disease characteristics, and there are still some problems that need to be solved.

The heated debate over NAFLD renaming: An ongoing saga

“…The ongoing debate between MAFLD/MASLD as potential replacements highlights the inherent challenge in reaching a consensus among different scientific societies, given the divergent viewpoints and stakes involved. [15] The introduction of unfamiliar acronyms only adds to this complexity, potentially leading to confusion or misinterpretation due to their initial lack of recognizability. [16] However, another critical aspect requires attention.…”