From NAFLD to MASLD: When metabolic comorbidity matters

Area of Science:

• Hepatology
• Metabolic Disorders
• Liver Disease Staging

Background:

• Non-alcoholic fatty liver disease (NAFLD) is being redefined as metabolic-associated steatotic liver disease (MASLD).
• Modified diagnostic criteria accompany the proposed nomenclature change.
• The impact of this reclassification on identifying significant liver fibrosis requires investigation.

Purpose of the Study:

• To evaluate the effectiveness of the proposed MASLD definition in identifying significant hepatic fibrosis.
• To compare the prevalence and risk factors of significant fibrosis between MASLD and Cryptogenic-SLD classifications.

Main Methods:

• Retrospective analysis of 428 patients with biopsy-proven hepatic steatosis diagnosed between 2009 and 2022.
• Classification of patients into NAFLD, MASLD, and Cryptogenic-SLD subgroups based on established and proposed criteria.
• Comparison of clinical-pathological features and analysis of risk factors for significant fibrosis in the MASLD cohort.

Main Results:

• MASLD patients exhibited greater histological disease severity compared to Cryptogenic-SLD.
• Significant fibrosis prevalence increased with the number of cardiometabolic risk factors (CMRF), reaching 42.5% with three or more (p=0.001).
• Independent risk factors for significant fibrosis in MASLD included lower albumin (ALB), lower platelet count (PLT), and more metabolic comorbidities.

Conclusions:

• The proposed MASLD nomenclature and criteria are more effective for identifying significant liver fibrosis than the previous NAFLD definition.
• Patients with three or more cardiometabolic risk factors represent a high-risk group for developing liver fibrosis.