Breaking new ground: MASLD vs. MAFLD-which holds the key for risk stratification?

Hepatol Int. 2024 Feb;18(1):168-178. doi: 10.1007/s12072-023-10620-y. Epub 2023 Dec 21.

Abstract

Background: The classification and nomenclature of non-alcoholic fatty liver disease (NAFLD) has been the subject of ongoing debate in the medical community. Through the introduction of metabolic dysfunction-associated fatty liver disease (MAFLD) and the later release of metabolic dysfunction-associated steatotic liver disease (MASLD), the limitations associated with NAFLD are intended to be addressed. Both terminologies incorporate the metabolic component of the disease by providing diagnostic criteria that relies on the presence of underlying metabolic risk factors.

Materials and methods: An epidemiologic cross-sectional study of individuals who had undergone abdominal ultrasound and vibration-controlled transient elastography (VCTE) as part of a routine check was performed. We evaluated clinical, anthropometric, and biochemical variables to determine the metabolic profile of each subject.

Results: The study included a total of 500 participants, 56.8% (n = 284) males and 43.2% (n = 216) females, with a mean age of 49 ± 10 years. 59.4% (n = 297) were diagnosed with MAFLD and MASLD, 10.2% (n = 51) were diagnosed only with MASLD and 30.4% (n = 152) were not diagnosed with either MAFLD or MASLD. The differences in prevalence were mainly based on the detection of individuals with a BMI < 25 kg/m2, where MASLD captures the largest number (p < 0.001).

Conclusions: Although MASLD has a higher capture of lean patients compared to MAFLD, patients with MAFLD and MASLD have a worse metabolic profile than those with only MASLD. Our results provide evidence that MAFLD better identifies patients likely to have a higher risk of liver fibrosis and of disease progression.

Keywords: Cardiovascular risk; Diabetes mellitus; Fatty liver; MAFLD; MASLD; Metabolic dysfunction; Obesity.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Metabolic Diseases*
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease* / diagnostic imaging
  • Non-alcoholic Fatty Liver Disease* / epidemiology
  • Risk Assessment
  • Risk Factors