From the Guidelines
The diagnosis of Metabolic Associated Fatty Liver Disease (MAFLD) requires evidence of hepatic steatosis plus at least one of three metabolic risk factors, as defined by the presence of one or more cardiometabolic risk factor(s) and the absence of harmful alcohol intake, according to the EASL-EASD-EASO clinical practice guidelines 1.
Diagnostic Criteria
The diagnostic criteria for MAFLD include:
- Hepatic steatosis confirmed by imaging (ultrasound, CT, or MRI), blood biomarkers, or liver biopsy showing fat accumulation in more than 5% of hepatocytes
- Presence of at least one cardiometabolic risk factor, such as:
- Overweight/obesity (BMI ≥25 kg/m² in Caucasians or ≥23 kg/m² in Asians)
- Type 2 diabetes mellitus
- Evidence of metabolic dysregulation, defined by the presence of at least two of the following conditions:
- Waist circumference ≥102/88 cm in men/women
- Blood pressure ≥130/85 mmHg or on treatment
- Triglycerides ≥150 mg/dL or on treatment
- HDL cholesterol <40/50 mg/dL in men/women or on treatment
- Prediabetes
- HOMA-IR score ≥2.5
- C-reactive protein level >2 mg/L
Importance of Early Diagnosis
Early diagnosis of MAFLD is crucial, as it can progress to more severe conditions like steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma if left untreated, as highlighted in the EASL-EASD-EASO clinical practice guidelines 1.
Recent Guidelines
The most recent guidelines from the EASL-EASD-EASO recommend a stepwise approach using blood-based scores (such as the fibrosis-4 index [FIB-4]) and, sequentially, imaging techniques (such as transient elastography) to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes 1.
Management
Management of MAFLD includes lifestyle modification, optimal management of comorbidities, and consideration of pharmacotherapy, such as resmetirom, for non-cirrhotic MASH with significant liver fibrosis, as recommended in the EASL-EASD-EASO clinical practice guidelines 1.
From the Research
Diagnostic Criteria for MAFLD
The diagnostic criteria for Metabolic Associated Fatty Liver Disease (MAFLD) include:
- Evidence of hepatic steatosis
- One of the following three criteria:
- Overweight/obesity
- Presence of type 2 diabetes mellitus
- Evidence of metabolic dysregulation 2
Key Characteristics of MAFLD
MAFLD is considered the liver manifestation of metabolic syndrome, and its prevalence is increasing worldwide in parallel to the epidemic of diabetes and obesity 3. The disease includes a wide spectrum of liver injury, including simple steatosis and non-alcoholic steatohepatitis (NASH), which may lead to serious complications such as liver cirrhosis and liver cancer.
Comparison with NAFLD
MAFLD is a new definition that replaces the old term nonalcoholic fatty liver disease (NAFLD), and it is associated with metabolic disorders 4. The novel diagnostic criteria for MAFLD can better help identify those with a high degree of disease severity for early intervention than the previous NAFLD criteria 5.
Diagnostic Techniques
Ultrasound attenuation parameters (UAP) can be used as a new noninvasive diagnostic technique to evaluate hepatic steatosis in MAFLD 6. The UAP values can be used to diagnose mild, moderate, and severe hepatic steatosis in MAFLD, with cut-off values of 243≤UAP＜258 dB/m, 258≤UAP＜293 dB/m, and ≥293 dB/m, respectively.
Prevalence and Risk Factors
MAFLD is a common disease in the general population, with a higher incidence in males and elderly females over 30 years of age 6. The prevalence rate is significantly higher in males than females, and it increases with age. UAP, alanine aminotransferase, and fasting blood glucose are independent risk factors for the progression of hepatic steatosis in MAFLD 6.