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Breaking new ground: MASLD vs. MAFLD—which holds the key for risk stratification?

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Abstract

Background

The classification and nomenclature of non-alcoholic fatty liver disease (NAFLD) has been the subject of ongoing debate in the medical community. Through the introduction of metabolic dysfunction-associated fatty liver disease (MAFLD) and the later release of metabolic dysfunction-associated steatotic liver disease (MASLD), the limitations associated with NAFLD are intended to be addressed. Both terminologies incorporate the metabolic component of the disease by providing diagnostic criteria that relies on the presence of underlying metabolic risk factors.

Materials and Methods

An epidemiologic cross-sectional study of individuals who had undergone abdominal ultrasound and vibration-controlled transient elastography (VCTE) as part of a routine check was performed. We evaluated clinical, anthropometric, and biochemical variables to determine the metabolic profile of each subject.

Results

The study included a total of 500 participants, 56.8% (n = 284) males and 43.2% (n = 216) females, with a mean age of 49 ± 10 years. 59.4% (n = 297) were diagnosed with MAFLD and MASLD, 10.2% (n = 51) were diagnosed only with MASLD and 30.4% (n = 152) were not diagnosed with either MAFLD or MASLD. The differences in prevalence were mainly based on the detection of individuals with a BMI < 25 kg/m2, where MASLD captures the largest number (p < 0.001).

Conclusions

Although MASLD has a higher capture of lean patients compared to MAFLD, patients with MAFLD and MASLD have a worse metabolic profile than those with only MASLD. Our results provide evidence that MAFLD better identifies patients likely to have a higher risk of liver fibrosis and of disease progression.

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Data availability

All data supporting the findings of this study are available within the paper.

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Funding

This study was partially supported by Medica Sur Clinic & Foundation. JG is supported by the Robert W. Storr Bequest to the Sydney Medical Foundation, University of Sydney; a National Health and Medical Research Council of Australia (NHMRC) Program Grant (APP1053206), Project, Ideas and Investigator Grants (APP2001692, APP1107178, APP1108422, APP1196492) and a Cancer Institute, NSW grant (2021/ATRG2028).

Author information

Authors and Affiliations

  1. Plan of Combined Studies in Medicine (PECEM-MD/PhD), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

    Mariana Michelle Ramírez-Mejía

  2. Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico

    Mariana Michelle Ramírez-Mejía & Nahum Méndez-Sánchez

  3. General Hospital “Dr. Manuel Gea González”, Mexico City, Mexico

    Carlos Jiménez-Gutiérrez

  4. Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia

    Mohammed Eslam & Jacob George

  5. Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

    Nahum Méndez-Sánchez

Authors
  1. Mariana Michelle Ramírez-Mejía
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  4. Jacob George
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  5. Nahum Méndez-Sánchez
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Contributions

Conception and design: NM-S. Material preparation, data collection and analysis were performed by MMR-M, NM-S and CJ-G. The first draft of the manuscript was written by MMR-M and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nahum Méndez-Sánchez.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Medica Sur Clinic & Foundation (protocol code 2021-EXT-552 and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ramírez-Mejía, M.M., Jiménez-Gutiérrez, C., Eslam, M. et al. Breaking new ground: MASLD vs. MAFLD—which holds the key for risk stratification?. Hepatol Int 18, 168–178 (2024). https://doi.org/10.1007/s12072-023-10620-y

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