What is metabolic dysfunction-associated fatty liver disease?

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a newly defined condition that represents a shift in understanding liver disease in relation to metabolic health. It’s a major cause of liver issues globally and is linked to metabolic conditions like obesity, type 2 diabetes and insulin resistance. This new definition aims to be more inclusive and accurate in capturing a wider range of patients affected by liver disease associated with metabolic dysfunction.

What is MAFLD, and what does it stand for?

MAFLD stands for metabolic dysfunction-associated fatty liver disease. It replaces the older term, non-alcoholic fatty liver disease (NAFLD). The new definition focuses on liver disease linked to metabolic health problems, making it clearer that these issues are often related to lifestyle and metabolic dysfunctions, such as obesity, type 2 diabetes and high cholesterol.

Why is this new definition needed?

The term NAFLD (non-alcoholic fatty liver disease) was criticised for focusing on what the condition isn’t - liver disease not caused by alcohol - rather than what it is. MAFLD more accurately reflects the condition's link to metabolic dysfunction, emphasising how metabolic health issues drive fat accumulation in the liver. This broader understanding helps clinicians focus on underlying causes like insulin resistance and obesity, which can lead to better-targeted treatments.

Does this definition mean more people will receive better care and earlier diagnosis?

Yes, the new definition is expected to lead to earlier diagnosis and more effective care. By highlighting the connection between metabolic dysfunction and liver disease, MAFLD creates a framework for healthcare providers to identify patients earlier, especially those with underlying metabolic conditions. The clearer criteria and broader scope make it easier to diagnose patients who may have been overlooked under the previous NAFLD definition. Early detection is key in preventing liver disease progression, such as fibrosis or cirrhosis.

What are the early symptoms for people to look out for?

In its early stages, MAFLD often doesn’t cause noticeable symptoms. However, certain signs could indicate the presence of the condition, and being aware of them is important for early detection. Symptoms to look out for include:

• Fatigue: Feeling unusually tired can be an early sign.
• Discomfort or pain in the upper right abdomen: This could indicate liver inflammation.
• Unexplained weight gain: Especially if it is associated with metabolic issues.
• Enlarged liver: Detected through a medical exam.
• Elevated liver enzymes: This can show up in blood tests even before symptoms are noticeable.

People with obesity, type 2 diabetes or metabolic syndrome should be particularly vigilant for these symptoms, as they are at higher risk.

How is MAFLD treated?

The treatment for MAFLD focuses on managing underlying metabolic dysfunction and preventing liver disease from progressing. Key treatments include:

• Lifestyle changes: Weight loss, regular exercise and a healthy diet low in refined sugars and unhealthy fats are crucial for managing MAFLD.
• Medical management: For patients with conditions like type 2 diabetes or high cholesterol, medications to control blood sugar and lipid levels can be part of treatment.
• Monitoring liver health: Regular follow-ups with liver function tests and imaging are important to track the disease's progression.
• Avoiding alcohol: Even though alcohol isn’t the primary cause of MAFLD, it can exacerbate liver damage, so it’s recommended to limit or avoid alcohol consumption.

By addressing the metabolic issues that contribute to fat buildup in the liver, MAFLD can be managed effectively, and further liver damage can often be prevented.