Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2021 Apr;27(2):257-269. doi: 10.3350/cmh.2021.0067. Epub 2021 Mar 22.
There is some dissatisfaction with the term "nonalcoholic fatty liver disease (NAFLD)," which overemphasizes alcohol and underemphasizes the importance of metabolic risk factors in this disease. Recently, a consensus recommended "metabolic (dysfunction)-associated fatty liver disease (MAFLD)" as a more appropriate term to describe fatty liver diseases (FLD) associated with metabolic dysfunction. During the definition change from NAFLD to MAFLD, subjects with FLD and metabolic abnormalities, together with other etiologies of liver diseases such as alcohol, virus, or medication who have been excluded from the NAFLD criteria, were added to the MAFLD criteria, while subjects with FLD but without metabolic abnormality, who have been included in the NAFLD criteria, were excluded from the MAFLD criteria. This means that there is an emphasis on the metabolic dysfunction in MAFLD which may underestimate the prognostic value of hepatic steatosis itself, whereas the MAFLD criteria might better identify subjects who are at a higher risk of hepatic or cardiovascular outcomes. However, non-metabolic risk NAFLD subjects who are excluded from the MAFLD criteria are missed from the diagnosis, and their potential risk can be the cause of future diseases. Although huge controversies remain, this review focused on summarizing recent studies that compared the clinical and prognostic characteristics between subjects with NAFLD and MAFLD.
人们对“非酒精性脂肪性肝病（NAFLD）”这一术语有些不满，因为它过分强调了酒精，而低估了代谢危险因素在这种疾病中的重要性。最近，一项共识建议使用“代谢（功能）障碍相关性脂肪性肝病（MAFLD）”作为一个更合适的术语来描述与代谢功能障碍相关的脂肪性肝病（FLD）。在从 NAFLD 到 MAFLD 的定义改变过程中，将代谢异常且存在 FLD 的患者，以及其他病因如酒精、病毒或药物导致的已被排除在 NAFLD 标准之外的肝脏疾病患者，纳入 MAFLD 标准；而代谢正常且存在 FLD 的患者，已被纳入 NAFLD 标准，则被排除在 MAFLD 标准之外。这意味着在 MAFLD 中更强调代谢功能障碍，这可能低估了肝脂肪变性本身的预后价值，而 MAFLD 标准可能更好地识别出存在更高肝脏或心血管结局风险的患者。然而，被排除在 MAFLD 标准之外的非代谢风险 NAFLD 患者则被漏诊，他们的潜在风险可能会导致未来的疾病。尽管仍存在巨大争议，但本篇综述主要关注比较 NAFLD 和 MAFLD 患者之间临床和预后特征的最近研究。
