MAFLD: A holistic view to redefining fatty liver disease

We thank Poniachik et al.,[1]Poniachik J.R.J. Roblero J.P. Urzua A. Cattaneo M. A new definition for non-alcoholic fatty liver disease.J Hepatol. 2021; 74: 982-983Abstract Full Text PDF Scopus (2) Google Scholar and Moreno al.,[2]Moreno C. Sheron N. Tiniakos D. Lackner Mathurin P. “Dual aetiology diseaseˮ: a recently proposed term associated with potential pitfalls.J 979-982Abstract their interest in our work[3]Eslam Newsome P.N. Sarin S.K. Anstee Q.M. Targher G. Romero-Gomez al.A metabolic dysfunction-associated disease: an international expert consensus statement.J 2020; 73: 202-209Abstract PubMed (668) Scholar,[4]Eslam Sanyal A.J. George J. MAFLD: consensus-driven nomenclature disease.Gastroenterology. 2020 May; 158 (1999-2014.e1)Abstract (634) acknowledging its multiple positive attributes. As they indicate, this includes the adoption of disease (MAFLD) as apt reflecting undisputed role dysfunction pathogenesis, diagnostic criteria based on specific inclusions not absence other diseases. The authors suggest that helps physicians to identify treat all risk factors those chronic through this, enables holistic care, clinical research development public health prevention policies. have raised some points we would be happy address. al., considered MAFLD may increase sensitivity but at cost decreased specificity. This is good point, case. explored aspect study 765 Japanese patients demonstrated identifies dysregulation, significant hepatic fibrosis kidney substantially better than NAFLD, regardless amount alcohol intake.[5]Yamamura S. Eslam Kawaguchi T. Tsutsumi Nakano Yoshinaga al.MAFLD NAFLD.Liver Int. Sep 30; https://doi.org/10.1111/liv.14675Crossref (89) In work, had higher compared NAFLD (91.7% vs. 73.0%), while specificity was almost identical (27.1% 29.7%). Second, worry might difficult healthcare team suggested alternatives such “obesity (OFLD)ˮ. unlikely case key patient associations including European Coalition People Living Obesity (EASO ECPO) expressed enthusiastic support “MAFLD” name criteria. Of particular relevance, meaningful pathophysiological sense importantly distanced from any pejorative links obesity.[6]Shiha Korenjak Eskridge W. Casanovas Velez-Moller Högström al.Redefining perspective.The Lancet Gastroenterol 2021 Jan; 6: 73-79Abstract (61) Additionally, OFLD problematic all-encompassing acronym since it common people who are obese, lean diabetic obese.[7]Eslam Fan J.-G. Mendez-Sanchez Non-alcoholic non-obese individuals: impact health.The Aug; 5: 713-715Abstract (19) Scholar,[8]Ye Q. Zou B. Yeo Y.H. Li Huang D.Q. Wu Y. Global prevalence, incidence outcomes 1 or NAFLD: meta-analysis 93 studies 10,576,383 persons.Lancet (in press): 2020Google Multiple organisations endorsed umbrella one simple easily applicable criteria.9Shiha Alswat K. Al Khatry Sharara A.I. Ormeci Waked I. al.Nomenclature metabolic-associated Middle East north Africa.Lancet 57-64Abstract (47) Scholar, 10Mendez-Sanchez Arrese Gadano Oliveira C.P. Fassio E. Arab al.The Latin American Association Study Liver (ALEH) position statement redefinition disease.The 65-72Abstract (49) 11Eslam Wong V.W.-S. Ahn S.H. Asian Pacific practice guidelines diagnosis management disease.Hepatol : 1-31PubMed al. concern about concept espoused paper,[3]Eslam “dual-aetiology disease”, which appears been misunderstood. Their core stems assumption disease” should “entity” used describe alcoholic disease. Based assumption, expand arguments separate individuals exposed consumption into two categories according weight (ALD normal dual overweight obese individuals) satisfying no longer recorded having ALD. simply put, like clarify critical important issue. What “concept” “term”, natural extension outcome switch Clearly, ALD different hepatitis Both fit under disease, entity itself, category. now consideration co-existing diseases, limited By analogy, “multimorbidity” commonly define coexistence diseases conditions.[12]Fortin Stewart Poitras M.-E. Almirall Maddocks H. systematic review prevalence multimorbidity: toward more uniform methodology.The Ann Fam Med. 2012; 10: 142-151Crossref (534) Similarly, “co-infection” another C B HIV.[13]Mattingly T.J. Pandit N.S. Onukwugha Burden Co-infection: analysis human immunodeficiency virus commercially insured population.Infect Dis Ther. 2019; 8: 219-228Crossref (4) Even literature, there abundance reports “co-existing” viral hepatitis.[14]Lin C.-W. Lin C.-C. Yang S.-S. Treatment prognosis concomitant alcoholism.Adv Treat Hepat 2017; 205Google Scholar,[15]Fong T.L. Kanel G.C. Conrad Valinluck Charboneau F. Adkins R.H. Clinical significance infection disease.Hepatology. 1994; 19: 554-557Crossref (88) examples, each keeps own name; category framework understanding these considerable populations. group alluded captured does negate WHO classification dissociation MALFD essential understand liver-related mortality. could agree advocate dropping reference dysfunction. However when co-exist, needs unpack individual synergistic contribution history outcomes. “dual overlooks importance reductions It very reason empathised safe limit noting every patient.[3]Eslam Scholar,[16]Eslam Toward accurate diseases.Gastroenterology. 157: 590-593Abstract (42) Thirdly, argue injury require prioritisation obesity frequently least important. They contend example cure reduction morbidity respectfully disagree, believe patient, must considered. At end spectrum severe (type 2 diabetes mellitus, cardiovascular dyslipidaemia) drink 10 g day other, 150 per day. Clinicians managing do fact make assessments prioritise risks achieve care. Treating only believe, belies complexity interactions. Using post HCV cure, emerging evidence indicates residual can offset beneficial SVR drive progression. German (1b) anti-D cohort, elevated BMI increased cirrhosis, even among long-term follow-up.[17]Wiese Fischer Löbermann Göbel U. Grüngreiff Güthoff al.Evaluation progression (1b)-contaminated cohort 35 years after infection.Hepatology. 2014; 59: 49-57Crossref (59) persisting steatosis 7.5-fold all-cause mortality hepatocellular carcinoma.[18]Peleg Issachar Sneh Arbib O. Cohen-Naftaly Harif Oxtrud al.Liver major predictor poor sustained virological response.J Viral Hepat. 26: 1257-1265Crossref (16) Therefore, without broad conceptual framework, care will well served. Finally, author’s echo, lot additive/synergistic effects between MAFLD. bidirectionality means patterns trajectories both conditions co-exist ignored. informs aspirational model treats risks, something misnomer used. thoroughly integrated trials traditionally excluded. conclusion, endeavours conceptualise redesign approach considers drivers levels – population levels, interwoven healthcare, health, social-care policies, ultimately improve outcomes, experience guide effective policy. M.E. J.G. supported by Robert Storr Bequest Sydney Medical Foundation , University National Health Research Council Australia (NHMRC) Program Grants ( APP1053206 APP1149976 ) Project grants APP1107178 APP1108422 ). equally contributed work. declare conflicts pertain Please refer accompanying ICMJE disclosure forms further details. following is/are supplementary data article: Download .pdf (.15 MB) Help pdf files Multimedia component An statementJournal HepatologyVol. 73Issue 1PreviewThe exclusion “excess” intake has until necessary establish (MAFLD). However, given current pathogenesis rising “positive criteria” diagnose required. panel experts 22 countries propose comprehensive simple, independent Full-Text diseaseJournal 74Issue 4PreviewWe read great article "A statement" published Journal Hepatology.1 true epidemic (NAFLD), currently affects 25% world's population, certainly requires attention decisions bring control .2 Consistent importance, seems start naming inclusive negation doing today. disease”: pitfallsJournal manuscript entitled “A statement”, Mohammed Eslam, Philip N colleagues.1