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Review
. 2023 Mar 13;11(3):883.
doi: 10.3390/biomedicines11030883.

From NAFLD to MAFLD: Definition, Pathophysiological Basis and Cardiovascular Implications

Andrea Boccatonda  1 , Lorenzo Andreetto  2 , Damiano D'Ardes  3 , Giulio Cocco  4 , Ilaria Rossi  3 , Susanna Vicari  1 , Cosima Schiavone  4 , Francesco Cipollone  3 , Maria Teresa Guagnano  3
Affiliations
Review

From NAFLD to MAFLD: Definition, Pathophysiological Basis and Cardiovascular Implications

Andrea Boccatonda et al. Biomedicines. .

Abstract

Non-alcoholic fatty liver disease (NAFLD) is defined as a chronic liver disease characterized by excessive fat accumulation in the liver without another obvious cause (no excessive alcohol consumption, hepatotoxic medications, toxins, viral infections, genetic hepatic diseases), therefore it is an exclusion diagnosis. The term NAFLD literally refers to non-alcohol related hepatopathy and does not adequately correlate with metabolic dysfunction and related cardiovascular risks. Therefore, researchers and scientific societies have moved towards changing the terminology. The novel nomenclature for a metabolic-associated fatty liver disease (MAFLD) has been proposed in 2020 by a group of experts to overcome the issues related to the old terminology. The diagnosis of MAFLD is based on the presence of hepatic steatosis and at least one between these three conditions: type 2 diabetes mellitus (T2DM), obesity or metabolic dysregulation. MAFLD has been shown to be an independent risk factor for cardiovascular diseases and atherosclerosis. It is better related to the main risk factors for atherosclerosis and cardiovascular diseases than NAFLD, such as dyslipidemia, T2DM and hypertension. The aim of this review is to highlight the reasons why the term NAFLD is moving to the term MAFLD, what are the conceptual basis of this choice and its clinical implications, particularly in the cardiovascular field.

Keywords: MAFLD; NAFLD; NASH; cardiovascular; diabetes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
MAFLD vs. NAFLD diagnostic criteria. * Metabolic risk abnormalities: (1) Waist circumference > 102/88 cm in caucasian men/women or > 90/80 cm in Asian men/women; (2) Blood pressure ≥ 130/85 mmHg or antihypertensive medication; (3) Plasma Triglycerides > 150 mg/dl or triglycerides lowering drugs; (4) Plasma HDL-C < 40 mg/dl for men and < 50 mg/dl for women or specific lipid lowering drugs; (5) Prediabetes or HbA1c between 5.7–6.4%; (6) Plasma high-sensitivity C-reactive protein level > 2 mg/L.
Figure 2
Figure 2
Graphic representation of principal therapeutic strategies in MAFLD.
See this image and copyright information in PMC

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