In theory, this paradigm shift would recognise and adequately emphasise the metabolic risk factors central to the condition’s development. As an alternative to NAFLD’s exclusionary diagnosis, MAFLD supports patient identification using positive diagnostic criteria, i.e. presence of overweight or obesity, type 2 diabetes mellitus, or evidence of metabolic dysfunction.
This review aimed to explore the change from NAFLD to MAFLD using historical, pathophysiological, and clinical perspectives.
The term ‘MAFLD’ places well-needed emphasis on the importance of metabolic alterations in the condition’s development. Indeed, obesity results in insulin resistance and subsequently impairs lipolysis inhibition while promoting free fatty acid (FFA) release and mobilisation to the liver. The presence of excessive hepatic FFAs generates lipotoxicity and promotes gluconeogenesis and de novo lipogenesis, two hallmarks of MAFLD’s onset. Furthermore, this new terminology addresses the entirety of the condition’s clinical spectrum, thereby preventing the exclusion of patients with metabolic alterations but low body mass indexes and/or mild-to-moderate alcohol consumption. Recent studies evaluating MAFLD’s clinical utility against that of NAFLD emphasise its superior ability to comprehensively classify and accurately diagnose high-risk patients, including those with more severe fibrosis as well as higher risks of disease progression, extra-hepatic complications, and mortality. These findings ultimately support the transition from NAFLD to MAFLD in day-to-day clinical settings.