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| NAFLD or MAFLD: That is the conundrum |
| Giovanni Tarantino * |
Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Naples, Italy
∗ Corresponding author.
E-mail address: giovanni.tarantino5@me.com |
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Abstract Where do we stand and where are we going? This question is of paramount importance in the light of the necessity of shedding light on the novel, controversial issue that is changing the acronym of nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD). The debate is deeply rooted in a multitude of unknown, or at the best scarcely understood, factors/phenomena involving various pieces of research and throwing up a range of different questions that need to be explored independently. Dealing with the NAFLD/MAFLD epidemiology, Zeng et al. should be praised for approaching a complex topic concerning this multifaceted disease that bears a noteworthy impact on health care system. They carried out an intriguing cross-sectional study published in this issue [1]. A large sample size population consisting of 9927 Chinese individuals were included in that clinical investigation. The authors, interestingly, found that the prevalence of MAFLD was significantly higher than that of NAFLD (40.3% vs. 36.9%). MAFLD was highly represented in patients affected by glucose dysmetabolism, specifically in those with type 2 diabetes mellitus (53.8%) and pre-diabetes, the latter including patients with impaired fasting glucose (35.7%) or impaired glucose tolerance (40.9%). High risk of advanced fibrosis based on fibrosis-4 (FIB-4) determination (one of the most interesting tests that we will discuss further) was detected in 14.7% of lean (body mass index, BMI < 23 kg/m2, Asian criterion) MAFLD subjects with type 2 diabetes mellitus. Among the whole population, 3481 (35.1%) subjects fulfilled the diagnostic criteria for MAFLD and NAFLD (MAFLD+NAFLD+), 521 individuals (5.2%) were labelled as MAFLD+NAFLD-, and 181 patients (1.8%) were identified as MAFLD-NAFLD+. The MAFLD+NAFLD- group showed more significant metabolic disorders than the MAFLD+NAFLD+ group. Among MAFLD-NAFLD+ subjects, 82.9% had metabolic disorders, emphasising that the NAFLD diagnosis, even though comprehending some criteria of the metabolic syndrome, does not always overlap the diagnosis of MAFLD. Anyway, these results clearly highlight the importance of tackling the metabolic syndrome presence in NAFLD patients, but with the clear evidence that a relatively few (nearly 2%) percentage of NAFLD patients does not fulfil the criteria of MAFLD. As pointed out by the authors of this study, over 82% of these previously mentioned patients (the so called MAFLD-NAFLD+) had one metabolic disorder.
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2022, Vol. 21 
