Metabolic dysfunction-associated steatotic liver disease of older people

Abstract

An international panel of experts proposes clear and simple criteria for the diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD), moving it from a disease of exclusion to one of inclusion. An international panel of experts from 22 countries proposes a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and independent of other liver diseases. The diagnosis is based on the rec ognition of underlying abnormalities in metabolic health, recognizing that MAFLD often coexists with other conditions. Future research will be useful in routine clinical practice. Further initiatives are now needed to subphenotype patients with MAFLD and fatty liver disease in general, to drive precision patient management and to create effective pathways between primary care and liver clinics. The criteria are in addition to one of the following three criteria: overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose a set of criteria to define cirrhosis associated with MAFLD and propose a concep tual framework to consider other causes of fatty liver disease. Finally, we clarify the distinction between diag nostic criteria and inclusion criteria for research studies and clinical trials. Based on the evidence of hepatic steatosis, achieving consensus on the criteria for MAFLD will help to unify terminology, enhance the legiti macy of clinical practice and clinical trials, improve clinical care, and advance the clinical and scientific field of liver research.

Keywords: Metabolic dysfunction, non-alcoholic fatty liver disease, liver cirrhosis