Redefining non-alcoholic fatty liver disease to metabolic associated fatty liver disease: Is this plausible?

Table 1 Evidence of non-alcoholic fatty liver disease vs metabolic associated fatty liver disease

No.	Ref.	Number of participants	Study type	Outcome measures	Result
1	Lin et al[27], 2020	13083	Cross-sectional, cohort from the National Health and Nutrition Examination Surveys III database	Significant fibrosis	Liver enzymes and the non-invasive liver fibrosis scores were significantly higher in MAFLD compared to NAFLD group (P < 0.05)
2	Yamamura et al[28], 2020	765	Cross-sectional Japanese cohort	Significant fibrosis	MAFLD (OR = 4.401; 95%CI: 2.144-10.629; P < 0.0001). NAFLD (OR = 1.721; 95%CI: 1.009-2.951; P = 0.0463)
3	Niriella et al[31], 2020	2985	A prospective study with 7 years of follow-up	Cardiovascular event CVD (non-fatal + fatal)	Excluded by NAFLD definition but captured by MAFLD definition adjusted OR [8.5 (2.2-32.8)]. Excluded by MAFLD definition but captured by NAFLD definition Adjusted OR [2.0 (0.2-19.2)]
4	Mak et al[15], 2020	1134	Cross-sectional chronic hepatitis B and fatty liver	Advanced fibrosis/ cirrhosis	Patients with CHB + MAFLD compared to patients with CHB + NAFLD outside the MAFLD criteria (22.6% vs 11.8%, P = 0.043)
5	Zheng et al[29], 2021	780	Cohort,(Liver biopsy)	Diagnostic criteria easily applicable even in a resource-limited country
6	Xu et al[30], 2020	35335	Cohort	Fatty liver index as a marker of hepatic steatosis	AUROC of FLI for predicting HS was 0.856 (95%CI: 0.854–0.859) in malesand 0.909 (95%CI: 0.906-0.911) in females, which showed a good diagnostic ability
7	Liu et al[41], 2021	361	Cross-sectional study, HIV and fatty liver disease	A positive correlation between LSM and CAP values was found in the MAFLD group	Prevalence of NAFLD (37.67%) and MAFLD (34.90%) (ALT) level (44.44% vs 16.17%, P < 0.001) and advanced fibrosis (19.05% vs 2.55%, P < 0.001) were significantly higher in the MAFLD group
8	Myers et al[42], 2021	920	Population cohort study	The burden of NAFLD and MAFLD associated HCCs increased significantly, driving an increase in HCC incidence, particularly in women.	Proportion of NAFLD-HCC increased more in women (0% to 29%, P = 0.037) than in men (2% to 12%, P = 0.010) while the proportion of MAFLD increased from 21% to 68% in both sexes and 7% to 67% in women (P < 0.001)
9	Guerreiro et al[43], 2021	1233	Retrospective cross-sectional study	Differences between NAFLD and MAFLD regarding cardiovascular events	MAFLD and NAFLD, CVR was intermediate/high (36.4 and 25.7%, P = 0.209) and CVD occurred in 20.1 and 12.8% (P = 0.137) of the cases, respectively
10	Ciardullo et al[44], 2021	1710	A cross-sectional study of adults recruited in the 2017- 2018 National Health and Nutrition Examination Survey, a representative sample of the general United States population.	Significant fibrosis	The weighted prevalence of NAFLD and MAFLD were similar in the whole population at 37.1% (95% CI 34.0-40.4) and 39.1% (95% CI 36.3-42.1) respectively.

NAFLD: Non-alcoholic fatty liver disease; MAFLD: Metabolic associated fatty liver disease; OR: Odds ratio; CI: Confidence interval; HCC: Hepatocellular carcinoma; CVD: Cardiovascular disease.