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[8]
potential role of pharmacological agents in adults with MASH with advanced liver fibrosis .

The Latin American Association for the Study of the Liver (ALEH) has also endorsed the shift of the
NAFLD definition to the “metabolic-associated fatty liver disease” as the official term for this pathology.
This change is particularly significant as this new definition improves the understanding and awareness of
the condition within the Latino-American population .
[30]
IMPACT OF MULTIPLE DEFINITIONS IN PEDIATRIC POPULATIONS
Previous studies have compared MAFLD and NAFLD definitions in the pediatric population. Xing et al., in
a cross-sectional observational study involving populations from China and the U.S., reported that more
than 75% of the patients with NAFLD met the criteria for MAFLD, while 19% of children with NAFLD did
[31]
not fulfill the MAFLD criteria, most of whom were of normal weight and without metabolic alterations .
Di Sessa et al., in a transversal study of 396 patients, found a prevalence of 39.6% for MASLD and 60.4% for
[32]
NAFLD, suggesting that MASLD identifies better than NAFLD children with obesity .
Another study involving a U.S. population reported that 99% of patients with NAFLD also fulfill the criteria
[33]
for MASLD, with Kappa = 0.90, indicating a strong agreement between the two definitions .
CONCLUSION
The former nomenclatures NAFLD, MAFLD, and recently MASLD represent an evolution in the
understanding of fatty liver disease as a complex metabolic syndrome, moving away from the exclusionary
and stigmatizing past definitions of fatty liver disease. This change in the nomenclature offers a more
accurate approach based on underlying metabolic pathophysiology. In the pediatric population, these new
definitions are particularly important, as the physiopathology in this group is more related to metabolic
causes like obesity and metabolic risk factors, which are increasing in children and adolescents. Although
this new nomenclature has improved diagnostic precision, challenges remain in terms of diagnosis,
management, and long-term outcomes for the pediatric population.

We recommend that the future research agenda should be focused on conducting longitudinal studies to
better understand the natural history of pediatric fatty liver disease, evaluate the safety and efficacy of
various therapeutic interventions for pediatrics, and develop and implement effective prevention strategies
to reduce the burden of this pathology. In addition, it is important to assess the impact of the MASLD
definition on the diagnosis, treatment, and follow-up of pediatric patients with fatty liver disease, comparing
its performance with earlier definitions.

DECLARATIONS
Authors’ contributions
Performed data acquisition, as well as providing administrative, technical, and material support: Gómez-
Mendoza R, Sánchez-Hernández F, Valentin-Cortez F, Chavez-Tapia N

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.