Prevalence of NAFLD, MAFLD and Associated Advanced Fibrosis in the Contemporary United States Population

Stefano Ciardullo; Gianluca Perseghin


Liver International. 2021;41(6):1290-1293. 

In This Article

Abstract and Introduction


Data are limited on the epidemiological implications of the recent change in terminology from nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD). We therefore performed a cross-sectional study of adults recruited in the 2017–2018 National Health and Nutrition Examination Survey, a representative sample of the general US population. The prevalence of NAFLD and MAFLD based on controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) obtained through vibration-controlled transient elastography (VCTE) were 37.1% (95% CI 34.0–40.4) and 39.1% (95% CI 36.3–42.1), respectively, with higher rates among Hispanic individuals. Agreement between the two definitions was high (Cohen's κ 0.92). Patients with NAFLD and MAFLD also showed similar risk of advanced liver fibrosis (7.5% and 7.4% respectively). Our results suggest that the recent change in diagnostic criteria did not affect the prevalence of the condition in the general United States population.


Recently, a panel of international experts proposed a new diagnostic entity called metabolic dysfunction-associated fatty liver disease (MAFLD), motivated by the need to overcome a diagnosis based on exclusion of other forms of liver disease and significant alcohol consumption (NAFLD, non-alcoholic fatty liver disease).[1] While this change in terminology is based on a growing understanding of the pathogenesis of fatty liver disease, few data are available on its implications in term of prevalence, risk of progression and diagnostic approach.[2,3] The present study was therefore conceived to obtain evidence on the prevalence of both conditions, their concordance and ability of identifying subjects with advanced liver fibrosis in the adult United States population.