Metabolically associated fatty liver disease: What hepatologists need to know about this systemic disease

Abstract

Metabolically associated fatty liver disease, recently redefined from non-alcoholic fatty liver disease, has emerged as the most common chronic liver disease worldwide. The new nomenclature emphasizes the metabolic drivers and highlights its strong links to extrahepatic disorders such as diabetes, cardiovascular disease, and chronic kidney disease. Yet, controversies remain regarding terminology, diagnostic thresholds, and the lack of effective disease-modifying drugs. This review discusses the rationale for the new definition, summarizes current knowledge of pathogenesis and the clinical spectrum, and highlights critical research gaps, including the role of gut microbiota, the need for improved risk stratification, and the evaluation of novel therapeutic classes.

Keywords: Metabolic associated fatty liver disease; Non-alcoholic fatty liver disease; Metabolic dysfunction-associated steatotic liver disease; Metabolic associated steatotic liver disease; Metabolic dysfunction-associated steatohepatitis; Diabetes mellitus; Viral hepatitis; Hepatocarcinoma

Core Tip: Metabolically associated fatty liver disease (MAFLD) is the new term replacing non-alcoholic fatty liver disease. Today, it is the most common chronic liver disease worldwide, affecting approximately 38% of the world's population. This comprehensive review offers insight into the various aspects of MAFLD, focusing on terminology, epidemiology, new findings on pathophysiology, key clinical factors, and current treatment options.