Deciphering the implications of the MAFLD and MASLD definitions in the NAFLD population: Results from a single-center biopsy study

Background In recent years, there has been a rising trend to replace the term non-alcoholic fatty liver disease (NAFLD). Two new acronyms, metabolic (dysfunction) associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD), have been proposed with unique diagnostic criteria.

Aim To investigate the applicability and agreement of the MAFLD and MASLD definitions in a population with biopsy-proven NAFLD.

Methods We conducted a retrospective analysis of prospectively collected data, focusing on patients with biopsy-proven NAFLD (n=678; 52.7% men) who were diagnosed and followed-up at a tertiary care center between 2009 and 2010, and from 2017 to 2023. The study patients were categorized using the diagnostic criteria for MAFLD and MASLD. To gauge the degree of agreement between the MAFLD and MASLD definitions, we used Cohen’s kappa values.

Results A total of 671 (99%) and 676 (99.7%) patients with NAFLD met the diagnostic criteria for MAFLD and MASLD, respectively. The Cohen’ kappa values for MAFLD and MASLD obtained using the NCEP-ATP III and AHA/NHLBI thresholds for waist circumference (≥102/88 cm and≥94/80 cm, respectively) were 0.397 and 0.442, respectively.

Conclusions MASLD encompassed a slightly larger proportion of patients with biopsy-proven NAFLD compared to MAFLD. The agreement between the two definitions was found to be moderate. Additional longitudinal studies are required to shed light on the clinical implications of this terminology change.

Publication History

Article published online:
23 January 2024