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Table 2. Summary of the key advantages and challenges of NAFLD, MAFLD, and MASLD nomenclatures
NAFLD MAFLD MASLD
Definition -Presence of hepatic steatosis in the -Hepatic steatosis with at least one -Hepatic steatosis plus at least one
absence of significant alcohol metabolic risk factor (obesity, T2DM, cardiometabolic risk factor, excluding cases with
consumption or other causes of liver fat or two metabolic risk factors) significant alcohol intake (> 20 g/day for women,
accumulation > 30 g/day for men)
Advantages -Extensive history in research and -Explicitly incorporates metabolic -Global consensus and standardization
clinical practice dysfunction -Explicit recognition of metabolic dysfunction
-Familiarity in clinical practice -Improves patient identification by -More inclusive and clinically relevant
-Established coding system focusing on metabolic dysfunction -Greater alignment with cardiometabolic risk
-Strong foundation for clinical trials -Eliminates the “non-alcoholic” label -Less stigmatizing terminology
-Minimal need for changes in guidelines -MAFLD allows for the coexistence -Encourages early detection and intervention
and protocols of other liver diseases -Promotes research and therapeutic
-Better alignment with cardiovascular advancements
risk stratification
Challenges -Lack of explicit metabolic criteria -Lack of global consensus -Transition and implementation difficulties
-Exclusion of patients with coexisting -Incompatibility with existing coding -Potential disruption of historical data
liver diseases systems -Need for education and awareness
-Stigmatizing terminology -Use of less commonly measured -Integration into international coding systems
-Negative definition by exclusion metabolic markers (such as HOMA- -Linguistic and cultural adaptation
-Limited reflection of cardiovascular risk IR and high-sensitivity CRP) -Lack of comprehensive genetic evaluation
-Lack of comprehensive genetic -Potential for misclassification
evaluation -Challenges in patient and provider
education
-Limited impact on reducing stigma
-Lack of comprehensive genetic
evaluation
NAFLD: Non-alcoholic fatty liver disease; MAFLD: metabolic-associated fatty liver disease; MASLD: metabolic dysfunction-associated steatotic
liver disease; T2DM: type 2 diabetes mellitus; HOMA-IR: homeostasis model assessment of insulin resistance; CRP: C-reactive protein.

DECLARATIONS
Authors’ contributions
Conducted the initial literature search and drafted the preliminary version of the manuscript: Iruzubieta P,
Crespo J
Contributed to the final writing, critical revision, and refinement of the manuscript: Jimenez-Gonzalez C,
Cabezas J
All authors read and approved the final version of the manuscript.

Availability of data and materials
Not applicable.

Financial support and sponsorship
Not applicable.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
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Copyright
© The Author(s) 2025.