What is metabolic dysfunction-associated fatty liver disease?

Written in association with: Dr Jeremy Cobbold
Published: | Updated: 23/10/2024
Edited by: Karolyn Judge

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.

By Dr Jeremy Cobbold
Hepatology (liver specialist)

Dr Jeremy Cobbold is a distinguished consultant hepatologist based in Oxford. Practising at The Manor Hospital and the John Radcliffe Hospital.

Dr Cobbold has considerable expertise in the diagnosis and management of a wide range of liver conditions, including investigating abnormal liver function tests, managing alcohol-related liver disease, non-alcohol fatty liver disease, cholestatic and autoimmune liver diseases, and cirrhosis. Dr Cobbold takes care to offer a relaxed consultation setting where patients are given sufficient time to voice all of their concerns.

Dr Cobbold qualified initially from the University of Cambridge and the University of London in 2001. He then underwent specialist training at some of the UK's top centres of excellence, including the Royal Free Hospital and St Mary's Hospital, Paddington.

While pursuing a PhD at Imperial College London, he developed an interest in teaching, first as clinical lecturer then honorary clinical lecturer in hepatology. In 2013, Dr Cobbold was appointed consultant hepatologist at the John Radcliffe Hospital, Oxford, where he is the clinical lead for hepatology.

Dr Cobbold runs a clinical research program in liver disease, as well as being the chair of the MASLD special interest group for the British Association for the Study of the Liver (BASL). As a honorary senior clinical lecturer at the University of Oxford, he continues to teach the next generation of medical trainees.

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