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Inicio Annals of Hepatology MAFLD or MASLD: Let the evidence decide again
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Vol. 29. Issue 5.
(September - October 2024)
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Vol. 29. Issue 5.
(September - October 2024)
Letters to the editor
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MAFLD or MASLD: Let the evidence decide again
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Ziyan Pan, Mohammed Eslam
Corresponding author
mohammed.eslam@sydney.edu.au

Corresponding author.
Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
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To the Editor:

We thank Ramírez-Mejíaa et al. [1] and Kamal et al. [2] for their interest and comments on our work [3]. A discussion about the redefinition of the most common liver disease, fatty liver disease due to metabolic dysfunction is still actively ongoing. Ramírez-Mejíaa et al. emphasize that time will ultimately determine the outcome of this discussion and any new version of diagnostic criteria must present significant conceptual advances over previous ones to be accepted.

Kamal et al. expressed concerns about the recently proposed definition of metabolic dysfunction-associated steatotic liver disease (MASLD) and the process that led to this outcome. They underscore the importance of distinguishing between consensus and evidence, the controversy surrounding the term and concept of MetALD [4,5], and question how changing "F" to "S" from metabolic dysfunction-associated fatty liver disease (MAFLD) to MASLD addressed previous concerns about the MAFLD definition. They also advocate for editorial flexibility when dealing with various disease nomenclatures.

Debates are inevitable in research, but they can only be resolved by relying on robust evidence rather than an eminence-based approach [6]. Within a short period, a significant amount of evidence has quickly accumulated, confirming that the definition of MAFLD identifies a more uniform group of patients with fatty liver caused by metabolic dysfunction. This surpasses not only the previous non-alcoholic fatty liver disease (NAFLD) definition but also the recently suggested MASLD definition. Therefore, MAFLD is currently the best available definition for this disease to date [7–12]. MAFLD presents a meaningful conceptual framework and practical definition and for approaching the disease and developing a patient-centred holistic approach to management considering multiple driving modes, with the ultimate aim of enhancing health outcomes. The emerging research signifies the beginning of a new era in reshaping the ongoing discussion by obtaining the essential evidence that will resolve the debate and open up new paths for further research. The only way to move forward is through additional studies and evidence.

In conclusion, the insights shared by Ramírez-Mejíaa et al. [1] and Kamal et al. [2] emphasize the importance of distinguishing between "evidence" and "opinion" in the field of medicine. It is crucial to engage in discussions and prioritize gathering evidence to resolve debates. Once robust evidence is available, it should guide our directions.

Acknowledgments

ME is supported by a National Health and Medical Research Council of Australia (National Cancer Institute NHMRC) Program Grant (APP1053206) and Project and Ideas grants (APP2001692, APP1107178 and APP1108422).

References
[1]
Ramírez-Mejíaa.
NAFLD-MASLD-MAFLD continuum: a swinging pendulum?.
Ann Hepatol, (2024),
[2]
E. Kamal.
MAFLD vs. MASLD: consensus is unlike evidence!.
Ann Hepatol, (2024),
[3]
Z. Pan, M. Derbala, K. AlNaamani, H. Ghazinian, J.G. Fan, M. Eslam.
MAFLD criteria are better than MASLD criteria at predicting the risk of chronic kidney disease.
[4]
Y. Fouad, F. Sanai, M. Alboraie, M.H. Zheng.
What the new definition of MASLD left behind: dual etiology with viral hepatitis.
Clin Gastroenterol Hepatol, (2023),
[5]
R.M.M. Méndez-Sánchez N.
MetALD: The outcome of living under the shadow of alcohol for 4 decades.
[6]
Y. Fouad, R. Elwakil, M. Elsahhar, E. Said, S. Bazeed, A. Ali Gomaa, et al.
The NAFLD-MAFLD debate: eminence vs evidence.
Liver Int, 41 (2021), pp. 255-260
[7]
J. Alharthi, A. Gastaldelli, I.H. Cua, H. Ghazinian, M. Eslam.
Metabolic dysfunction-associated fatty liver disease: a year in review.
Curr Opin Gastroenterol, 38 (2022), pp. 251-260
[8]
Z. Pan, S.A. Al-Busafi, M. Abdulla, Y. Fouad, G. Sebastiani, M. Eslam.
MAFLD identifies patients with significant hepatic fibrosis better than MASLD.
[9]
Z. Pan, M. Eslam, A. Choudhury, B. Sahoo, C.R. Lesmana, FM. Sanai.
The MASLD criteria overlook a number of adolescent patients with severe steatosis.
[10]
Z. Pan, G. Shiha, G. Esmat, N. Méndez-Sánchez, M. Eslam.
MAFLD predicts cardiovascular disease risk better than MASLD.
[11]
M.M. Ramírez-Mejía, C. Jiménez-Gutiérrez, M. Eslam, J. George, N. Méndez-Sánchez.
Breaking new ground: MASLD vs. MAFLD—which holds the key for risk stratification?.
Hepatol Int, 18 (2024), pp. 168-178
[12]
X.D. Zhou, A. Lonardo, C.Q. Pan, M.D. Shapiro, M.H. Zheng, WMU MAFLD Clinical Research Working Group.
Clinical features and long-term outcomes of patients diagnosed with MASLD, MAFLD, or both.
Copyright © 2024. Fundación Clínica Médica Sur, A.C.
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