Abstract
Dear Editor,
Herein, the Asia Pacific Pediatric Association (APPA) expresses its full endorsement to the metabolic dysfunction associated fatty liver disease (MAFLD) as more apt and precise definition to fatty liver disease in pediatrics.1–5
Formerly, the term, non-alcoholic fatty liver disease (NAFLD) created numerous problems when it was used for children, as including the word ‘alcohol’ in the name did not produce any sense when conveying information to parents. In addition, NAFLD was defined on the basis of excluding other causes of chronic liver disease, and there always have been concerns raised regarding over-diagnosing and excessively investigating this condition.
The new definition of fatty liver disease is quite simple, practical, and comprehensive for the diagnosis in children as it considers the heterogeneity of the fatty liver disease. It provides simple criteria for the diagnosis of MAFLD on the presence of metabolic dysfunction, which is key underlying pathogenesis of the disease. As in adults, a significant proportion of pediatric patients with MAFLD (around 40%) are non-obese. This further emphasizes the importance of consideration of metabolic health in the definition of fatty liver disease, as it occurs in the MAFLD definition.6–8
In addition, this new definition and through positive criteria distinguishes MAFLD from the fatty liver with other identifiable systemic disorders, including malnutrition and emphasizes the need for further studies regarding the pathogenic basis of fatty liver without a clear underlying defect. This definition is amenable to the potential coexistence of more than one cause of chronic liver disease and means that clinicians are not compelled to search for rare causes of fatty liver but can instead follow their own clinical judgment. The other positive attribute of the MAFLD criteria is that it can be easily incorporated into standard healthcare packages which would then improve in its detection, particularly in the primary care setting, and allow for efficient referral and management.9,10
In conclusion, APPA enthusiastically endorses the MAFLD definition, similar to other Global multi-stakeholders and considers it a pivotal step in our ongoing efforts to increase awareness regarding the prevention and management of MAFLD.
