Tang SY, Tan JS, Pang XZ, Lee GH. Metabolic dysfunction associated fatty liver disease: The new nomenclature and its impact. World J Gastroenterol 2023; 29(3): 549-560 [PMID: 36688021 DOI: 10.3748/wjg.v29.i3.549]
Corresponding Author of This Article
Guan-Huei Lee, FRCP, MBBS, MRCP, PhD, Assistant Professor, Attending Doctor, Doctor, Division of Gastroenterology and Hepatology, National University Hospital, 1E, Kent Ridge Road, Singapore 119228, Singapore. guan_huei_lee@nuhs.edu.sg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 21, 2023; 29(3): 549-560 Published online Jan 21, 2023. doi: 10.3748/wjg.v29.i3.549
Metabolic dysfunction associated fatty liver disease: The new nomenclature and its impact
Si-Ying Tang, Jian Shiun Tan, Xian-Zheng Pang, Guan-Huei Lee
Si-Ying Tang, Guan-Huei Lee, Division of Gastroenterology and Hepatology, National University Hospital, Singapore 119228, Singapore
Jian Shiun Tan, Xian-Zheng Pang, Yong Loo Lin School of Medicine, Singapore 117597, Singapore
Author contributions: Tang SY, Tan JS and Pang XZ contributed equally to this work; Tang SY, Tan JS, Pang XZ and Lee GH designed the research study; Tang SY, Tan JS and Pang XZ performed the research; Tang SY, Tan JS, Pang XZ and Lee GH analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guan-Huei Lee, FRCP, MBBS, MRCP, PhD, Assistant Professor, Attending Doctor, Doctor, Division of Gastroenterology and Hepatology, National University Hospital, 1E, Kent Ridge Road, Singapore 119228, Singapore. guan_huei_lee@nuhs.edu.sg
Received: September 24, 2022 Peer-review started: September 24, 2022 First decision: October 30, 2022 Revised: November 14, 2022 Accepted: December 23, 2022 Article in press: December 23, 2022 Published online: January 21, 2023
Abstract
BACKGROUND
In 2020, an international expert panel proposed a new definition of fatty liver: Metabolic dysfunction-associated fatty liver disease (MAFLD). The MAFLD added the criteria for defining metabolic dysfunctions, which are high-risk factors for liver-related and cardiovascular events. Contrary to the non-alcoholic fatty liver disease (NAFLD) definition, it allows the coexistence of MAFLD and significant alcohol use in the same patient.
AIM
To review the existing data that evaluate the clinical profile and long-term outcome difference between the patients identified as MAFLD and NAFLD.
METHODS
Databases MEDLINE via PubMed and EMBASE were searched and relevant publications up to June 28, 2022 were assessed. Studies were included if they involved human participants diagnosed with MAFLD.
RESULTS
A total of 2324 records were reviewed, of which 1575 duplicate citations were removed. Of the 2324 records screened, 207 articles were excluded, and 542 articles were assessed for their eligibility, for which 511 were excluded. The remaining 31 articles were selected for review. MAFLD diagnostic criteria were able to identify more individuals with fatty liver. Studies have shown that patients included using the MAFLD criteria were associated with higher risks of hepatic fibrosis when compared to NAFLD. All-cause mortality, cardiovascular disease-related, and cancer-related mortality were shown to be higher in MAFLD patients. MAFLD patients also had higher baseline metabolic derangement, and risks of developing obesity, diabetes, and cardiovascular events. Of the 3 subtypes, diabetes mellitus has the strongest association with negative outcomes, followed by metabolic dysfunction and elevated body mass index. Within the subtypes of MAFLD, patients with more metabolic conditions at the time of diagnosis had worse hepatic and liver injury compared to those with a single metabolic condition.
CONCLUSION
MAFLD is a new definition of fatty liver disease that is gaining increasing acceptance. It is based on empirical clinical practice on positive inclusion of metabolic risk factors and recent evidence suggests that it helps to identify patients with higher risk for liver-related as well as cardiovascular events.
Core Tip: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new definition of fatty liver disease that is based on positive inclusion of metabolic risk factors. Studies have shown that patients included using the MAFLD criteria were associated with higher risks of hepatic fibrosis and all cause mortality when compared to non-alcoholic fatty liver disease.
