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Cited by 3Liver Disease Diagnosis and TreatmentAlcohol Consumption and Health EffectsLiver Diseases and Immunity

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Comparison of prevalence of fatty liver disease according to the different nomenclatures of NAFLD, MAFLD, and MASLD in a large Iranian Population-based study

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Isfahani, Marjan Moallemian, Sepanlou, Sadaf G., Joukar, Farahnaz, Mansour-Ghanaei, Fariborz, Taheri, Ehsaneh·2025·Scientific Reports
DOI 10.1038/s41598-025-30226-8PMC PMC12780078
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Abstract

The terminology and diagnostic criteria for fatty liver disease have undergone recent evolution, from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD), and more recently to metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to compare the estimated prevalence of FLD with that of NAFLD, MAFLD, and MASLD using different definitions. Data were analyzed from 10,520 participants in the first phase of the Guilan Persian Cohort Study, part of the nationwide PERSIAN Cohort. Participants were classified based on NAFLD, MAFLD, and MASLD. Of 10,520 participants, 5,025 (47.8%) had a fatty liver index (FLI) ≥ 60 and were diagnosed with SLD. The prevalence of MASLD, MAFLD, and NAFLD was 33.7%, 47.6%, and 33.7%, respectively, while 4.5% (n = 471) were classified as metabolic dysfunction-associated alcohol-related liver disease (MetALD). Among those with NAFLD, 99.7% also met MAFLD criteria, and all met MASLD criteria. MAFLD was associated with the highest adjusted odds of elevated FIB-4 (OR: 1.27; 95% CI: 1.24-1.30) and hepatic steatosis index (OR: 2.01; 95% CI: 1.82-2.21). NAFLD and MASLD had a similar, lower prevalence compared to MAFLD. MetALD was not included under MASLD but was encompassed by MAFLD.

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References 30 · Cited by 3

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  1. Younossi, Z. M. et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology 77(4), 1335–1347 (2023). · DOI · Paper page
  2. Eslam, M. et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J. Hepatol. 73(1), 202–209 (2020). · DOI · Paper page
  3. Rinella, M. E. et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 78 (6), 1966–1986 (2023). PubMed PMID: 37363821. Pubmed Central PMCID: PMC10653297. · DOI · Paper page
  4. Zou, H., Ma, X., Pan, W. & Xie, Y. Comparing similarities and differences between NAFLD, MAFLD, and MASLD in the general U.S. Population. Front. Nutr. 11, 1-11, 1411802 (2024) · DOI
  5. Huang, X. et al. Comparison of NAFLD, MAFLD, and MASLD Prevalence and Clinical Characteristics in Asia Adults. J. Clin. Experimental Hepatol. 15(1), 102420 (2025). · DOI
  6. Tabaeian, S. P. et al. Prevalence of Non-alcoholic Fatty Liver Disease in Iran: A Systematic Review and Meta-analysis. J. Clin. Exp. Hepatol. 14(1), 101209 (PubMed PMID: 38076354. Pubmed Central PMCID: PMC10709132. Epub 2023/12/11. eng.). · DOI
  7. Jafari, E. et al. Prevalence and characteristics of metabolic Dysfunction-Associated fatty liver disease among an Iranian adult population with ethnic and genetic diversity: results of the PolyIran-Liver study. Middle East. J. Dig. Dis. 16 (2), 86–95 (2024). PubMed PMID: 39131113. Pubmed Central PMCID: PMC11316194. Epub 2024/08/12. eng. · DOI
  8. Mansour-Ghanaei, F. et al. The PERSIAN Guilan cohort study (PGCS). Arch. Iran. Med. 22 (1), 39–45 (2019). PubMed PMID: 30821159. Epub 2019/03/02. eng.
  9. Park, H. J., Lee, S. & Lee, J. S. Differences in the prevalence of NAFLD, MAFLD, and MASLD according to changes in the nomenclature in a health check-up using MRI-derived proton density fat fraction. Abdom. Radiol. (NY). 49 (9), 3036–3044 (2024). PubMed PMID: 38587630. Epub 2024/04/08. eng. · DOI
  10. Lim, G. E. H. et al. An observational data Meta-analysis on the differences in prevalence and risk factors between MAFLD vs NAFLD. Clin. Gastroenterol. Hepatol. 21 (3), 619–629 (2023). e7. PubMed PMID: 34871813. Epub 2021/12/07. eng. · DOI
  11. Guo, Z. et al. Global burden of MAFLD, MAFLD related cirrhosis and MASH related liver cancer from 1990 to 2021. Sci. Rep. 15(1), 7083 (2025). · DOI
  12. Suzuki, K. et al. Concordance between metabolic dysfunction-associated steatotic liver disease and nonalcoholic fatty liver disease. Hepatol. Res. 54 (6), 600–605 (2024). PubMed PMID: 38234088. Epub 2024/01/18. eng. · DOI
  13. Barritt ASt, Yu, F. et al. High concordance between nonalcoholic fatty liver disease and metabolic Dysfunction-Associated steatotic liver disease in the TARGET-NASH Real-World cohort. Am. J. Gastroenterol. 119 (8), 1624–1627 (2024). PubMed PMID: 38587293. Epub 2024/04/08. eng. · DOI
  14. Priego-Parra, B. A., Bernal-Reyes, R., Icaza-Chávez, M. E., Martínez-Vázquez, S. E. & Remes-Troche, J. M. Transitioning from NAFLD to MAFLD to MASLD in the Mexican population. Revista de Gastroenterología de México (English Edition). 2025/01/01/;90(1):153–156. (2025). · DOI
  15. Kaya, E. & Yilmaz, Y. Deciphering the implications of MAFLD and MASLD definitions in the NAFLD population: results from a single-center biopsy study. Chin. Med. J. 137 (05), 616–618 (2024). · DOI
  16. Ng, C-H. et al. IDDF2022-ABS-0132 Mafld and Nafld in lean individuals. A prospective analysis of 12,505 lean individuals. Gut.17(2), A50.1-A50 (2022). · DOI
  17. Ji, H. & Cheng, S. Sex differences in prevalence and prognosis of steatotic liver disease phenotypes: Biological sex matters. J Hepatol. 80(2), e68-e9. PubMed PMID: 37619929. Pubmed Central PMCID: PMC10873108. Epub 2023/08/25. eng. (2024). · DOI
  18. Schneider, K. M. & Schneider, C. V. A new era for steatotic liver disease: evaluating the novel nomenclature in the UK biobank. J. Hepatol. 80 (2), e58–e60 (2024). · DOI
  19. Polyzos, S. A. & Goulis, D. G. Menopause and metabolic dysfunction-associated steatotic liver disease. Maturitas 186, 108024 (2024). PubMed PMID: 38760254. Epub 2024/05/18. eng. · DOI
  20. Chen, J., Mao, X., Deng, M. & Luo, G. Validation of nonalcoholic fatty liver disease (NAFLD) related steatosis indices in metabolic associated fatty liver disease (MAFLD) and comparison of the diagnostic accuracy between NAFLD and MAFLD. Eur. J. Gastroenterol. Hepatol. 35(4), 394–401 (2023). · DOI
  21. Xu, X. et al. The role of fibrosis index FIB-4 in predicting liver fibrosis stage and clinical prognosis: A diagnostic or screening tool? J. Formos. Med. Assoc.121(2):454–466. (2022). · DOI
  22. Priego-Parra, B. A. et al. Hepatic steatosis index (HSI): A valuable biomarker in subjects with metabolic Dysfunction-associated fatty liver disease (MAFLD). Ann. Hepatol. 2024/02/01/;29:101391. (2024). · DOI
  23. Deng, Y., Chen, W. & Xie, W. MASLD identifies patients with significant hepatic fibrosis and steatosis in fatty liver population. Ann. Hepatol. 29(3):101488. (2024). · DOI
  24. Zeng, H. et al. Prognostic and predictive effects of new steatotic liver disease nomenclatures: a large population-based study. MedComm. 13: 6(2):e70087 (2025). PubMed PMID: 39949980. Pubmed Central PMCID: PMC11822458. Epub 2025/02/14. eng. (2020). · DOI
  25. Poustchi, H. et al. Prospective epidemiological research studies in Iran (the PERSIAN cohort Study): rationale, objectives, and design. Am. J. Epidemiol. 187 (4), 647–655 (2018). · DOI
  26. Han, A. L. Validation of fatty liver index as a marker for metabolic dysfunction-associated fatty liver disease. Diabetol. Metab. Syndr. 14(1), 44 (2022). · DOI
  27. Nomura, T. et al. Validation of fatty liver index as a predictor of hepatic steatosis in Asian populations: impact of alcohol consumption and sex. Hepatol. Res. 53 (10), 968–977 (2023). · DOI
  28. Lee, J-H. et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig. Liver Disease. 42 (7), 503–508 (2010). · DOI
  29. Sugiyama, A., Kurisu, A., Ouoba, E. B., Ko, S. & Rakhimov, K. Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups. BMC Gastroenterol. 22(1), 241 (2022). · DOI
  30. Jeong, S. et al. Development of a simple nonalcoholic fatty liver disease scoring system indicative of metabolic risks and insulin resistance. Ann. Transl Med. 8(21), 1–12 (2020).
  31. Yilmaz, Y. (ed) Editor the Heated Debate Over NAFLD Renaming: an Ongoing Saga. Hepatology Forum, 7; 4(3): 89-91(2023). · DOI
  32. Chen, L., Tao, X., Zeng, M., Mi, Y. & Xu, L. Clinical and histological features under different nomenclatures of fatty liver disease: NAFLD, MAFLD, MASLD and MetALD. J. Hepatol. 80 (2), e64–e6 (2024). · DOI

Metadata

Authors
Isfahani, M. M., Sepanlou, S. G., Joukar, F., Mansour-Ghanaei, F., & Taheri, E.
Affiliations
  • Digestive Disease Research Institute (IR)
  • Tehran University of Medical Sciences (IR)
  • Guilan University of Medical Sciences (IR)
Corresponding author
Taheri, Ehsaneh
ORCID
Venue
Scientific Reports
Publisher
Springer Science and Business Media LLC
Published
2025-12-08
Volume
16
Issue
1
Pages
742-742
ISSN
2045-2322 (ISSN-L)
DOI
10.1038/s41598-025-30226-8
PMC
PMC12780078
OpenAlex
W4417106575
Cited by
3
References
30
Citations by year
2026: 3
FWCI
2.08
Type
journal article
Language
en
Open access
Licence
Locations
  • Scientific Reports (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords
hepatic steatosis, non-alcoholic fatty liver disease, disease nomenclature, prevalence, fatty liver index, FIB-4, hepatic steatosis index, Iranian population
MeSH terms
Adult, Aged, Fatty Liver, Female, Humans, Iran, Male, Middle Aged, Cohort Studies, Prevalence, Non-alcoholic Fatty Liver Disease

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