Renaming NAFLD to MAFLD: Could the LDE System Assist in This Transition?

Abstract

Our understanding of fatty liver syndromes and their relationship with the metabolic syndrome has improved over recent decades and, paralleling this, we are now at the dawn of the NAFLD (nonalcoholic fatty liver disease) to MAFLD (metabolic-associated fatty liver disease) transition. The pitfalls of NAFLD diagnosis, together with disappointing results in therapeutic trials, and the inconsistencies and risks inherent in a “negative” definition (such as “nonalcoholic”) as opposed to a “positive” one (i.e., “metabolic”) are predicted to facilitate the proposed renaming of NAFLD to MAFLD. However, a premature change of terminology would not necessarily address major unmet needs in this area, and may even become counterproductive. As an aid to selecting more homogeneous cohorts of patients, I propose the LDE (Liver, Determinants, Extra-hepatic) classification system which, in principle, may help to assess the natural course of disease as well as the efficacy of novel drugs in patients with NAFLD/MAFLD.

The Risk of Colorectal Adenoma in Nonalcoholic or Metabolic-Associated Fatty Liver Disease

“…However, liver biopsy is not typically used in asymptomatic individuals in clinical practice, and radiographic techniques, such as ultrasonography or magnetic resonance imaging, are used for the diagnosis of NAFLD. Third, although MAFLD and NAFLD are not entirely equivalent conditions [44], and the FIB-4 index was initially described to predict fibrosis in patients with NAFLD [25], we used the FIB-4 index in both patients with MAFLD and NAFLD. Fourth, although ADR might be influenced by interval and previous colonoscopy results, this study included subjects who underwent screening or surveillance colonoscopy.…”

Separating the apples from the oranges: from NAFLD heterogeneity to personalized medicine

“…The confluence, in variable proportions, of the two principal NAFLD forms may ultimately contribute to shaping a potentially uncountable variety of clinical phenotypes and disease outcomes. [2,19]. In its essence, the LDE system requires clarification of nine criteria that should be recorded to better characterize cohorts of patients.…”

From nonalcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease: more than a single-letter change in an acronym

“…That said, polarizing opinions and major debate have recently arisen in hepatology on the proposed change of nomenclature and diagnostic criteria for MAFLD [8][9][10][19][20][21] . In this context, a recent commentary written by an international panel of experts, led by Polyzos et al [22] , has recognized that the newly proposed definition of MAFLD is expected to more accurately reflect the heterogeneous pathogenesis of this liver disease, focusing on the metabolic abnormalities which play a key role in its development and progression.…”

“…As elegantly espoused by Eslam and George [38] , among the many positive attributes of the proposed change of terminology from NAFLD to MAFLD, we should not lose sight of the fact that it has generated a momentum of its own that should now be encouraged rather than emasculated. The debates are inevitable and also very useful in science, but they should be mostly based on the evidence of data rather than the eminence of opinions, because only the evidence of data can settle them and clear the way forward [19][20][21][22][23][39][40][41] In the era of evidence-based medicine, the need for an evidence-based debate on the proposed change of NAFLD terminology is clinically essential [21] . Very recently, some scientific societies have reached a consensus to endorse the proposal that NAFLD should be renamed as MAFLD and that this metabolic liver disease should be diagnosed by simple and easily applicable "positive" criteria [42][43][44][45] .…”

“…Some authors have also endorsed the new terminology of MAFLD for the use in the pediatric population and proposed a set of specific cut-off points, which might be useful to diagnose MAFLD in children and adolescents [48] . However, I believe that it is mandatory that an international consensus conference should be jointly organized by the "major" relevant scientific societies of hepatology/gastroenterology, diabetology, and obesity along with the patient advocacy organizations, biopharmaceutical industry, regulatory agencies, and policy makers to deeply discuss all potential implications of a change of terminology from NAFLD to MAFLD [5,7,19] .…”