Non-Alcoholic Fatty Liver Diseases To Metabolic Dysfunction-Associated Fatty Liver Diseases: a Paradigm Shift

Abstract

NAFLD has historically been diagnosed by excluding other liver diseases and alcohol use, but given its global prevalence (~30%), recent evidence has prompted its reconceptualization as metabolic dysfunction-associated fatty liver disease (MAFLD) to reflect a metabolism-centered pathogenesis. This review explores the conceptual, clinical, and policy implications of the renaming of NAFLD to MAFLD, examining etiological and diagnostic differences, clinical outcomes, controversies, and future research and policy directions. A critical review of peer-reviewed studies, consensus statements, and policy reports was conducted to evaluate the implications of this nomenclature transition. MAFLD offers a positive diagnostic framework requiring metabolic dysfunction, including patients previously excluded (e.g., those with coexisting liver etiologies) and identifying a higher-risk cohort with more metabolic comorbidities and worse outcomes, such as increased cardiovascular and renal complications. The MAFLD shift influences research design and enhances clinical recognition, but introduces challenges for global consensus, regulatory coding alignment, and comparability with historical NAFLD data. In conclusion, MAFLD provides a more inclusive, clinically relevant model focusing on metabolic drivers and personalized, multidisciplinary care. However, unresolved controversies (including some expert opposition), coding inconsistencies, and global policy inertia hinder its full adoption, indicating a need for harmonized terminology, updated clinical guidelines, and improved public health strategies..

Keywords: NAFLD, MAFLD, Metabolic Dysfunction, Fatty Liver Disease, Clinical Diagnosis, Public Health Policy, Liver Disease Classification.