Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Med Sci Monit. 2024 Jul 30;30:e945198. doi: 10.12659/MSM.945198.
Emerging in the 1800s under the label "fat in the liver" and later gaining prominence in the 1980 as non-alcoholic fatty liver disease (NAFLD), the disease predominantly attributed to metabolic dysfunction presents a formidable health issue marked by substantial morbidity and mortality. It was 2020 when a change of one letter "NAFLD" to metabolic dysfunction-associated fatty liver disease "MAFLD" linked with the change in the definition and diagnostic criteria began a new controversy around the globe. Metabolic dysfunction-associated fatty liver disease (MAFLD) criteria represent a substantial departure from previous diagnostic measures of NAFLD, and provide the first set of positive criteria for diagnosis of the disease in adults and children that emphasise the key attribute of metabolic dysfunction in the pathogenesis, and acknowledges that the disease is a continuum across the life span. In 2023, an adapted version of the diagnostic criteria of MAFLD was proposed to define a slightly modified term; metabolic dysfunction-associated steatotic liver disease (MASLD). The MASLD criteria did not provide any conceptual advantage, and emerging evidence suggests that it actually performs worse than the MAFLD criteria. This raises the intriguing question of why MASLD was unable to take advantage of being second? In this review, we will explore the possible reasons for this unique case and highlight the current evidence supporting the use of MAFLD instead of MASLD in defining metabolic dysfunction-associated fatty liver diseases.
在 19 世纪，这种疾病被贴上了“肝脏脂肪”的标签，后来在 20 世纪 80 年代因非酒精性脂肪性肝病（NAFLD）而受到关注，主要归因于代谢功能障碍，它是一个严重的健康问题，其特点是发病率和死亡率都很高。2020 年，将“NAFLD”中的一个字母“N”改为“代谢功能障碍相关脂肪性肝病”（MAFLD），并随之改变了定义和诊断标准，这在全球范围内引发了一场新的争议。代谢功能障碍相关脂肪性肝病（MAFLD）标准与之前 NAFLD 的诊断措施有很大的不同，为成人和儿童提供了诊断该疾病的第一套阳性标准，强调了代谢功能障碍在发病机制中的关键属性，并承认该疾病是贯穿整个生命周期的疾病。2023 年，提出了 MAFLD 诊断标准的改编版本，以定义一个略微修改的术语；代谢功能障碍相关脂肪性肝病（MASLD）。MASLD 标准并没有提供任何概念上的优势，而且新出现的证据表明，它的表现实际上不如 MAFLD 标准。这就提出了一个有趣的问题，为什么 MASLD 不能利用其排名第二的优势呢？在这篇综述中，我们将探讨这种独特情况的可能原因，并强调目前支持使用 MAFLD 而不是 MASLD 来定义代谢功能障碍相关脂肪性肝病的证据。
