Democracy in Science

MAFLD vs. MASLD: a year in review

INTRODUCTION

In 2023, metabolic dysfunction-associated steatotic liver disease (MASLD) was introduced following metabolic dysfunction-associated fatty liver disease (MAFLD). Both aim to address the limitations of nonalcoholic fatty liver disease (NAFLD). This review analyzes the similarities and differences between MAFLD and MASLD, focusing on their impacts on epidemiology, diagnosis, stigma, and related liver diseases.

AREAS COVERED

Current evidence suggests that MAFLD criteria effectively identify individuals at higher risk through a good balance of sensitivity and specificity. Moreover, MAFLD is a more generalizable term that is easily understood globally.

EXPERT OPINION

The transition from NAFLD to MAFLD and MASLD marks a significant advance in understanding fatty liver disease within hepatology. MAFLD identifies a homogeneous cohort of patients with fatty liver due to metabolic dysfunction and provides a valuable framework for holistic, patient-centered management strategies that consider various contributing factors to improve health outcomes.

NAFLD to MAFLD: collaboration, not confusion - rethinking the naming of fatty liver disease

The recent shift from “non-alcoholic fatty liver disease” (NAFLD) and “metabolic associated fatty liver disease” (MAFLD) to “metabolic dysfunction-associated steatotic liver disease” (MASLD) has raised questions about its scientific basis and impact on patient understanding. This renaming may create confusion rather than clarity. A collaborative approach involving healthcare professionals, researchers, and patients to establish terminology that balances scientific accuracy with accessibility is needed. Effective disease naming should be accurate, unique, consistent, objective, and accessible - qualities essential for clear communication in healthcare. Disease name is more than scientific correctness because naming conventions for public use, especially anything related to health, must be a matter of convenience, ethics, and cultural and social acceptance. Education and straightforward communication should take precedence over renaming, helping patients and healthcare providers fully understand the complexities and implications of liver disease for treatment. After all, from a scientific and public health perspective, MAFLD has clear advantages over MASLD.

Could controversies in the arena of fatty liver disease be a potential gate for the democratization of science

The term “democratization of science” describes the process of more evenly allocating epistemic authority between scientists, members of dominant civilizations, and the academic community at large, or members of less dominant societies. This means that it includes initiatives aimed at democratizing the decision-making process by acknowledging the presence of diverse types of “wisdom of crowd” and so reducing the barriers between the various stakeholders. Our purpose is to separate influence from involvement that contributes to the breakdown of conventional closed-circuit authority structures and to prevent future abuses of power by academic institutions, scientific societies, and even individual opinion leaders. A conceptual framework for comprehending the idea of the democratization of science is presented in this perspective piece. Our considerations are pertinent to the politics of widespread academic engagement in scientific decision-making, even though they were spurred by the discussion surrounding the definitions of fatty liver disease.