Clin Mol Hepatol.  2021 Apr;27(2):257-269. 10.3350/cmh.2021.0067.

From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

  • 1Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 2Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
  • 3Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
  • 4Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
  • 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 6Yonsei Liver Center, Severance Hospital, Seoul, Korea
  • 7Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea


There is some dissatisfaction with the term “nonalcoholic fatty liver disease (NAFLD),” which overemphasizes alcohol and underemphasizes the importance of metabolic risk factors in this disease. Recently, a consensus recommended “metabolic (dysfunction)-associated fatty liver disease (MAFLD)” as a more appropriate term to describe fatty liver diseases (FLD) associated with metabolic dysfunction. During the definition change from NAFLD to MAFLD, subjects with FLD and metabolic abnormalities, together with other etiologies of liver diseases such as alcohol, virus, or medication who have been excluded from the NAFLD criteria, were added to the MAFLD criteria, while subjects with FLD but without metabolic abnormality, who have been included in the NAFLD criteria, were excluded from the MAFLD criteria. This means that there is an emphasis on the metabolic dysfunction in MAFLD which may underestimate the prognostic value of hepatic steatosis itself, whereas the MAFLD criteria might better identify subjects who are at a higher risk of hepatic or cardiovascular outcomes. However, non-metabolic risk NAFLD subjects who are excluded from the MAFLD criteria are missed from the diagnosis, and their potential risk can be the cause of future diseases. Although huge controversies remain, this review focused on summarizing recent studies that compared the clinical and prognostic characteristics between subjects with NAFLD and MAFLD.


Non-alcoholic fatty liver disease; Metabolic (dysfunction)-associated fatty liver disease; Outcome; Metabolic syndrome; Diabetes mellitus
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