Teng ML, Ng CH, Huang DQ, Chan KE, Tan DJ, Lim WH, Yang JD, Tan E, Muthiah MD. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29(Suppl):S32. https://doi.org/10.3350/cmh.2022.0365.

Article  PubMed  Google Scholar 

Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. https://doi.org/10.1002/hep.28431.

Article  PubMed  Google Scholar 

Riazi K, Azhari H, Charette JH, Underwood FE, King JA, Afshar EE, Swain MG, Congly SE, Kaplan GG, Shaheen AA. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022. https://doi.org/10.1016/S2468-1253(22)00165-0.

Article  PubMed  Google Scholar 

Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24(7):908–22. https://doi.org/10.1038/s41591-018-0104-9.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, George J, Bugianesi E. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15(1):11–20. https://doi.org/10.1038/nrgastro.2017.109.

Article  PubMed  Google Scholar 

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE, Loomba R. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;17:10–97. https://doi.org/10.1097/HEP.0000000000000323.

Article  Google Scholar 

Dai W, Ye L, Liu A, Wen SW, Deng J, Wu X, Lai Z. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis. Medicine. 2017;96(39):e8179. https://doi.org/10.1097/MD.0000000000008179.

Article  PubMed  PubMed Central  Google Scholar 

•• Eslam M, Sanyal AJ, George J, Sanyal A, Neuschwander-Tetri B, Tiribelli C, Kleiner DE, Brunt E, Bugianesi E, Yki-Järvinen H, Grønbæk H. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158(7):1999–2014. https://doi.org/10.1053/j.gastro.2019.11.312. The expert consensus statement proposing the change in nomenclature from NAFLD to MAFLD. The change in nomenclature is prompted to reflect current understanding of disease pathogenesis and account for the heterogeneity of patients affected by this condition.

Article  CAS  PubMed  Google Scholar 

Méndez-Sánchez N, Bugianesi E, Gish RG, Lammert F, Tilg H, Nguyen MH, Sarin SK, Fabrellas N, Zelber-Sagi S, Fan JG, Shiha G. Global multi-stakeholder endorsement of the MAFLD definition. Lancet Gastroenterol Hepatol. 2022;7(5):388–90. https://doi.org/10.1016/S2468-1253(22)00062-0.

Article  Google Scholar 

• Lonardo A, Bril F, Caldwell SH, Eslam M, Fan JG, Gish RG, Gronbaek H, Sanal MG, Stefan N, Suzuki A, Targher G. Researchers call for more flexible editorial conduct rather than abruptly adopting only the new MASLD nomenclature. J Hepatol. 2024. https://doi.org/10.1016/j.jhep.2024.01.012. An editorial letter from key researchers highlighting the debate regarding the interchangeable use of NAFLD, MAFLD and MASLD terminologies. Concerns highlighting confusion amongst the scientific and patient communities which can impede future research and insights if MASLD terminology is enforced indiscriminately.

Article  PubMed  Google Scholar 

•• Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2023;24: 101133. https://doi.org/10.1097/HEP.0000000000000520. Multi-society Delphi consensus statement describing the process for introducing the latest fatty liver disease nomenclature of MASLD and its new diagnostic criteria and disease subtypes.

Article  Google Scholar 

Younossi ZM, Paik JM, Stepanova M, Ong J, Alqahtani S, Henry L. Clinical profiles and mortality rates are similar for metabolic dysfunction-associated steatotic liver disease and non-alcoholic fatty liver disease. J Hepatol. 2024. https://doi.org/10.1016/j.jhep.2024.01.014.

Article  PubMed  Google Scholar 

•• Bassal T, Basheer M, Boulos M, Assy N. Nonalcoholic fatty liver disease—a concise review of noninvasive tests and biomarkers. Metabolites. 2022;12(11):1073. https://doi.org/10.3390/metabo12111073. A review providing a concise summary of non-invasive scores, biomarkers and imaging modalities for the diagnosis and assessment of steatohepatitis and fibrosis. Pathophysiological mechanisms including lipotoxicity and impairments in glucose metabolism have been proposed as being implicated in the disease process of NAFLD.

Article  CAS  PubMed  PubMed Central  Google Scholar 

• Ramírez-Mejía MM, Jiménez-Gutiérrez C, Eslam M, George J, Méndez-Sánchez N. Breaking new ground: MASLD vs. MAFLD—which holds the key for risk stratification? Hepatol Int. 2024;18(1):168–78. https://doi.org/10.1007/s12072-023-10620-y. Diagnostic criteria of MAFLD more accurately identifies patients with high risk of liver fibrosis compared to the MASLD criteria. Patients that have met both MASLD and MAFLD criteria were observed to have a worse metabolic profile compared to those who met the MASLD criteria alone.

Article  PubMed  Google Scholar 

• Loomba R, Wong VW. Implications of the new nomenclature of steatotic liver disease and definition of metabolic dysfunction-associated steatotic liver disease. Aliment Pharmacol Ther. 2024;59(2):150–6. https://doi.org/10.1111/apt.17846. Majority of patients with NAFLD fulfil the new diagnostic criteria of MASLD, although the complete adoption of this nomenclature and criteria in future clinical trials may take time. The new terminology offers the opportunity for new research that can improve our understanding of epidemiology, diagnosis, and management strategies across the spectrum of this disease.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Armstrong MJ, Adams LA, Canbay A, Syn WK. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology. 2014;59(3):1174–97. https://doi.org/10.1002/hep.26717.

Article  CAS  PubMed  Google Scholar 

Kim D, Choi SY, Park EH, Lee W, Kang JH, Kim W, Kim YJ, Yoon JH, Jeong SH, Lee DH, Lee HS. Nonalcoholic fatty liver disease is associated with coronary artery calcification. Hepatology. 2012;56(2):605–13. https://doi.org/10.1002/hep.25593.

Article  CAS  PubMed  Google Scholar 

Maurice J, Manousou P. Non-alcoholic fatty liver disease. Clin Med. 2018;18(3):245. https://doi.org/10.7861/clinmedicine.18-3-245.

Article  Google Scholar 

Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. The Lancet. 2021;397(10290):2212–24. https://doi.org/10.1016/S0140-6736(20)32511-3.

Article  CAS  Google Scholar 

Hagström H, Nasr P, Ekstedt M, Hammar U, Stål P, Hultcrantz R, Kechagias S. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265–73. https://doi.org/10.1016/j.jhep.2017.07.027.

Article  PubMed  Google Scholar 

Vilar-Gomez E, Calzadilla-Bertot L, Wong VW, Castellanos M, Aller-de la Fuente R, Metwally M, Eslam M, Gonzalez-Fabian L, Sanz MA, Conde-Martin AF, De Boer B. Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease: a multi-national cohort study. Gastroenterology. 2018;155(2):443–57. https://doi.org/10.1053/j.gastro.2018.04.034.

Article  PubMed  Google Scholar 

• Kouvari M, Valenzuela-Vallejo L, Guatibonza-Garcia V, Polyzos SA, Deng Y, Kokkorakis M, Agraz M, Mylonakis SC, Katsarou A, Verrastro O, Markakis G. Liver biopsy-based validation, confirmation and comparison of the diagnostic performance of established and novel non-invasive steatotic liver disease indexes: Results from a large multi-center study. Metabolism. 2023;147: 155666. https://doi.org/10.1016/j.metabol.2023.155666. The diagnostic performance of non-invasive scores is variable and further validation across different patient populations is required. Assessment of these non-invasive scores and biomarkers against different histological stages of the disease may improve their diagnostic application in clinical practice.

Article  CAS  PubMed  Google Scholar 

• Campos-Murguía A, Ruiz-Margáin A, González-Regueiro JA, Macías-Rodríguez RU. Clinical assessment and management of liver fibrosis in non-alcoholic fatty liver disease. World J Gastroenterol. 2020;26(39):5919. https://doi.org/10.3748/wjg.v26.i39.5919. A comprehensive review summarising non-invasive scores and imaging for the assessment of NAFLD with a proposal for a practical approach to the evaluation and management of patients. Liver fibrosis is the main liver-related factor associated with adverse clinical outcomes and mortality in patients.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640–5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644.

Article  CAS  PubMed  Google Scholar 

Kyrou I, Randeva HS, Tsigos C, Kaltsas G, Weickert MO. Clinical problems caused by obesity. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc. 2018.

Das K, Chowdhury A. oi NASH: distinctiveness and clinical implication. Hep Intl. 2013;7:806–13. https://doi.org/10.1007/s12072-013-9477-5.

Article  Google Scholar 

Cataldo I, Sarcognato S, Sacchi D, Cacciatore M, Baciorri F, Mangia A, Cazzagon N, Guido M. Pathology of non-alcoholic fatty liver disease. Pathologica. 2021;113(3):194. https://doi.org/10.32074/1591-951X-242.

Article  PubMed  PubMed Central  Google Scholar 

Yu JH, Lee HA, Kim SU. Noninvasive imaging biomarkers for liver fibrosis in nonalcoholic fatty liver disease: current and future. Clin Mol Hepatol. 2023;29(Suppl):S136. https://doi.org/10.3350/cmh.2022.0436.

Article  PubMed  Google Scholar 

Nogami A, Yoneda M, Iwaki M, Kobayashi T, Honda Y, Ogawa Y, Imajo K, Saito S, Nakajima A. Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: present and future. Clin Mol Hepatol. 2023;29(Suppl):S123. https://doi.org/10.3350/cmh.2022.0357.

Article  PubMed  Google Scholar 

Jang W, Song JS. Non-invasive imaging methods to evaluate non-alcoholic fatty liver disease with fat quantification: a review. Diagnostics. 2023;13(11):1852. https://doi.org/10.3390/diagnostics13111852.

Article  PubMed  PubMed Central  Google Scholar 

Trujillo MJ, Chen J, Rubin JM, Gao J. Non-invasive imaging biomarkers to assess nonalcoholic fatty liver disease: A review. Clin Imaging. 2021;78:22–34. https://doi.org/10.1016/j.clinimag.2021.02.039.

Article  PubMed  Google Scholar 

Zhou JH, Cai JJ, She ZG, Li HL. Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol. 2019;25(11):1307. https://doi.org/10.3748/WJG.V25.I11.1307.

Article  CAS  PubMed  PubMed Central  Google Scholar 

• Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(5):1264–81. https://doi.org/10.1053/j.gastro.2018.12.036. The differentiation of NASH from simple steatosis and early identification of advanced fibrosis are the most crucial end-points for patients with NAFLD. An expert proposal of how noninvasive tools may be used in routine clinical practice is described along with key areas for future research.