MASLD vs. MAFLD. A narrative review

Here, the history of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis nomenclatures is summarized. Metabolic dysfunction-associated fatty liver disease (MAFLD) was coined in 2020, and metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed in 2023. With this ba...

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Main Authors: Amedeo Lonardo, Ming-Hua Zheng, Mohammed Eslam
Format: Article
Language:English
Published: Open Exploration Publishing Inc. 2025-08-01
Series:Exploration of Digestive Diseases
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Online Access:https://www.explorationpub.com/uploads/Article/A100586/100586.pdf
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author Amedeo Lonardo
Ming-Hua Zheng
Mohammed Eslam
author_facet Amedeo Lonardo
Ming-Hua Zheng
Mohammed Eslam
author_sort Amedeo Lonardo
collection DOAJ
description Here, the history of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis nomenclatures is summarized. Metabolic dysfunction-associated fatty liver disease (MAFLD) was coined in 2020, and metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed in 2023. With this backset, the present article aims at reviewing the similarities and differences between MAFLD and MASLD through a systematic analysis of published comparative studies. MAFLD and MASLD have a complex disease spectrum comprising, further to all-cause mortality, hepatic (fibrosis, cirrhosis, and primary liver cancer) and extrahepatic outcomes (major adverse cardiovascular events, chronic kidney disease, extrahepatic cancers, type 2 diabetes, and vascular dementia). Comparative studies document that—due to its superior ability to identify liver fibrosis—MAFLD better captures mortality owing to all-causes, hepatic and extrahepatic outcomes, which are strongly associated with the severity of liver fibrosis. Moreover, MASLD is inappropriate in pediatric care, lacks specificity, tends to overdiagnosis, does not consider coexistent viral hepatitis or lean subjects, and amplifies disease heterogeneity. Collectively, the evidence presented in this narrative review supports an urgent need for the development of evidence-based guideline statements. This novel developmental process should involve not only a systematic review of the evidence, with equal contribution from all the world’s regions of stakeholders and clinical panelists, but also should use quantitative data to identify an objective-level consensus to guarantee wide adoption of the process outcomes.
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spelling doaj-art-a87c9b9864fc4f76850d076e7e00eea42025-08-20T03:03:16ZengOpen Exploration Publishing Inc.Exploration of Digestive Diseases2833-63212025-08-01410058610.37349/edd.2025.100586MASLD vs. MAFLD. A narrative reviewAmedeo Lonardo0https://orcid.org/0000-0001-9886-0698Ming-Hua Zheng1https://orcid.org/0000-0003-4984-2631Mohammed Eslam2Azienda Ospedaliero-Universitaria di Modena (–2023), 41100 Modena, ItalyMAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou 325000, Zhejiang, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, Zhejiang, ChinaStorr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW 2145, AustraliaHere, the history of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis nomenclatures is summarized. Metabolic dysfunction-associated fatty liver disease (MAFLD) was coined in 2020, and metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed in 2023. With this backset, the present article aims at reviewing the similarities and differences between MAFLD and MASLD through a systematic analysis of published comparative studies. MAFLD and MASLD have a complex disease spectrum comprising, further to all-cause mortality, hepatic (fibrosis, cirrhosis, and primary liver cancer) and extrahepatic outcomes (major adverse cardiovascular events, chronic kidney disease, extrahepatic cancers, type 2 diabetes, and vascular dementia). Comparative studies document that—due to its superior ability to identify liver fibrosis—MAFLD better captures mortality owing to all-causes, hepatic and extrahepatic outcomes, which are strongly associated with the severity of liver fibrosis. Moreover, MASLD is inappropriate in pediatric care, lacks specificity, tends to overdiagnosis, does not consider coexistent viral hepatitis or lean subjects, and amplifies disease heterogeneity. Collectively, the evidence presented in this narrative review supports an urgent need for the development of evidence-based guideline statements. This novel developmental process should involve not only a systematic review of the evidence, with equal contribution from all the world’s regions of stakeholders and clinical panelists, but also should use quantitative data to identify an objective-level consensus to guarantee wide adoption of the process outcomes.https://www.explorationpub.com/uploads/Article/A100586/100586.pdfhistory of medicinemetabolic dysfunction-associated fatty liver disease (mafld)metabolic dysfunction-associated steatotic liver disease (masld)natural coursenonalcoholic fatty liver disease (nafld)nomenclaturesphilosophy of science
spellingShingle Amedeo Lonardo
Ming-Hua Zheng
Mohammed Eslam
MASLD vs. MAFLD. A narrative review
Exploration of Digestive Diseases
history of medicine
metabolic dysfunction-associated fatty liver disease (mafld)
metabolic dysfunction-associated steatotic liver disease (masld)
natural course
nonalcoholic fatty liver disease (nafld)
nomenclatures
philosophy of science
title MASLD vs. MAFLD. A narrative review
title_full MASLD vs. MAFLD. A narrative review
title_fullStr MASLD vs. MAFLD. A narrative review
title_full_unstemmed MASLD vs. MAFLD. A narrative review
title_short MASLD vs. MAFLD. A narrative review
title_sort masld vs mafld a narrative review
topic history of medicine
metabolic dysfunction-associated fatty liver disease (mafld)
metabolic dysfunction-associated steatotic liver disease (masld)
natural course
nonalcoholic fatty liver disease (nafld)
nomenclatures
philosophy of science
url https://www.explorationpub.com/uploads/Article/A100586/100586.pdf
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