Unifying Concepts

Diagnosis of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new concept proposed in 2020. Unlike non-alcoholic fatter liver disease (NAFLD), the diagnosis of MAFLD requires the presence any of the following 3 metabolic risks, including overweight/obesity, presence of diabetes mellitus, and evidence of metabolic dysregulation.

Flowchart for the proposed “positive” diagnostic criteria for MAFLD

Hepatic steatosis in adults (detected either by imaging techniques, blood biomarkers/scores or by liver histology), with at least one of the following:

  1. Overweight or obesity (defined as BMI ≥25 kg/m2 in Caucasians or BMI ≥23 kg/m2 in Asians)
  2. Type 2 diabetes mellitus (According to widely accepted international criteria)
  3. Lean/normal weight (defined as BMI <25 kg/m2 in Caucasians or BMI <23 kg/m2 in Asians): If presence of at least two metabolic risk abnormalities:
    • Waist circumference ≥102/88 cm in Caucasian men and women (or ≥90/80 cm in Asian men and women)
    • Blood pressure ≥130/85 mmHg or specific drug treatment
    • Plasma triglycerides ≥150 mg/dl (≥1.70 mmol/L) or specific drug treatment
    • Plasma HDL-cholesterol <40 mg/dl (<1.0 mmol/L) for men and <50 mg/dl (<1.3 mmol/L) for women or specific drug treatment
    • Prediabetes (i.e., fasting glucose levels 100 to 125 mg/dl [5.6 to 6.9 mmol/L], or 2-hour post-load glucose levels 140 to 199 mg/dl [7.8 to 11.0 mmol] or HbA1c 5.7% to 6.4% [39 to 47 mmol/mol])
    • Homeostasis model assessment (HOMA) of insulin resistance score ≥2.5
    • Plasma high-sensitivity C-reactive protein level >2 mg/L

Criteria for a diagnosis of MAFLD-related cirrhosis
Patients with cirrhosis in the absence of typical histology who meet at least one of the following criteria:

  • Past or present evidence of metabolic risk factors that meet the criteria to diagnose MAFLD, with at least one of the following:
    1. Documentation of MAFLD on a previous liver biopsy*.
    2. Historical documentation of steatosis by hepatic imaging*.

*History of past alcohol intake should be considered as patients may have a dual disease aetiology with alcohol use disorder. MAFLD, metabolic dysfunction-associated fatty liver disease.



  1. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, Zelber-Sagi S, Wai-Sun Wong V, Dufour JF, Schattenberg JM, Kawaguchi T, Arrese M, Valenti L, Shiha G, Tiribelli C, Yki-Järvinen H, Fan JG, Grønbæk H, Yilmaz Y, Cortez-Pinto H, Oliveira CP, Bedossa P, Adams LA, Zheng MH, Fouad Y, Chan WK, Mendez-Sanchez N, Ahn SH, Castera L, Bugianesi E, Ratziu V, George J. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol. 2020 Jul;73(1):202-209. [Medline]
  2. Lin S, Huang J, Wang M, Kumar R, Liu Y, Liu S, Wu Y, Wang X, Zhu Y. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int. 2020 Sep;40(9):2082-2089. [Medline]


Created Dec 31, 2020.

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