From nonalcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease: more than a single-letter change in an acronym

Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized public health problem worldwide. To emphasize the close pathophysiological links between NAFLD and overweight/obesity, insulin resistance, and related metabolic comorbidities, a consensus statement of international experts in 2020 has recommended to replace the old acronym NAFLD with “metabolic dysfunction-associated fatty liver disease” (MAFLD). A set of “positive” criteria to diagnose MAFLD, regardless of daily alcohol consumption, has also been proposed. A “positive” definition of MAFLD and its special focus on the metabolic causative drivers of this liver disease is expected to reduce patient confusion on disease etiology, which can, in turn, improve the identification and awareness of this common and burdensome liver disease among both primary care physicians and specialists. However, the proposal to change the terminology from NAFLD to MAFLD is still under intense discussion, as also recently highlighted by a panel of international experts (led by Dr. Polyzos and Mantzoros), which is the main topic of discussion of this commentary. Further studies are required to better understand whether, and how, the proposed changes to the diagnostic criteria for MAFLD may impact on the risk of adverse hepatic and extra-hepatic clinical outcomes