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Byrne et al. Metab Target Organ Damage 2024;4:10 Metabolism and
DOI: 10.20517/mtod.2024.06
Target Organ Damage

Perspective Open Access

MASLD, MAFLD, or NAFLD criteria: have we re-
created the confusion and acrimony surrounding

metabolic syndrome?

Christopher D. Byrne 1,# , Giovanni Targher 2,3,#
1
National Institute for Health and Care Research, Southampton Biomedical Research Centre, University Hospital Southampton
and University of Southampton, Southampton SO16 6YD, UK.
2
Department of Medicine, University of Verona, Verona 37126, Italy.
3
Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella (VR) 37024, Italy.
#
Authors contributed equally.
Correspondence to: Prof. Christopher D. Byrne, National Institute for Health and Care Research, Southampton Biomedical
Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Tremona
Road, Southampton SO16 6YD, UK. E-mail: c.d.byrne@soton.ac.uk
How to cite this article: Byrne CD, Targher G. MASLD, MAFLD, or NAFLD criteria: have we re-created the confusion and
acrimony surrounding metabolic syndrome? Metab Target Organ Damage 2024;4:10. https://dx.doi.org/10.20517/mtod.2024.
06

Received: 17 Jan 2024 First Decision: 6 Feb 2024 Revised: 7 Feb 2024 Accepted: 20 Feb 2024 Published: 27 Feb 2024
Academic Editor: Sonia Najjar Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
In 1980, there was the first description of patients with nonalcoholic steatohepatitis (NASH), most of whom were
overweight and had type 2 diabetes. In the following years, there has been a growing appreciation that metabolic
dysfunction underpins this liver disease, and metabolic dysfunction also contributes to the increased risk of
extrahepatic complications, manifest in nonalcoholic fatty liver disease (NAFLD) as a multisystem disease. In 2020
& 2023, it was proposed that NAFLD should be renamed and reclassified as metabolic dysfunction-associated fatty
liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), respectively. Despite
subtle differences between MAFLD and MASLD, there is excellent congruence between NAFLD, MAFLD, and
MASLD definitions, and affected patients usually meet the criteria for all. The following is a perspective of the
authors’ views as to the challenges and advantages of the new fatty liver disease terminology and classification.

Keywords: Insulin resistance, metabolic syndrome, metabolic dysfunction-associated fatty liver disease, MAFLD,
metabolic dysfunction-associated steatotic liver disease, MASLD, nonalcoholic fatty liver disease, NAFLD,
cardiovascular disease, extrahepatic complications

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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