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World J Hepatol. Jun 27, 2022; 14(6): 1087-1098
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1087
Metabolic-associated fatty liver disease from childhood to adulthood: State of art and future directions
Francesca Lanzaro, Stefano Guarino, Elisabetta D'Addio, Alessandra Salvatori, Josè Alberto D'Anna, Pierluigi Marzuillo, Emanuele Miraglia del Giudice, Anna Di Sessa
Francesca Lanzaro, Stefano Guarino, Elisabetta D'Addio, Alessandra Salvatori, Josè Alberto D'Anna, Pierluigi Marzuillo, Emanuele Miraglia del Giudice, Anna Di Sessa, Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Author contributions: Lanzaro F wrote the first draft of the manuscript; Miraglia del Giudice E, Di Sessa A, and Marzuillo P conceived the manuscript; Di Sessa A, Miraglia del Giudice E, and Marzuillo P supervised the manuscript drafting; D'Addio E, Salvatori A, Guarino S, and D'Anna JA reviewed the literature data; Guarino S and Lanzaro F prepared the tables; all author contributed important intellectual content during manuscript drafting or revision.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pierluigi Marzuillo, MD, PhD, Assistant Professor, Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 2, Naples 80138, Italy. pierluigi.marzuillo@gmail.com
Received: October 18, 2021
Peer-review started: October 18, 2021
First decision: December 3, 2021
Revised: December 26, 2021
Accepted: April 25, 2022
Article in press: April 25, 2022
Published online: June 27, 2022
Processing time: 247 Days and 15.5 Hours
Abstract

In 2020, an international group of experts proposed to replace the term of nonalcoholic fatty liver disease with metabolic-associated fatty liver disease (MAFLD). This recent proposal reflects the close association of fatty liver with metabolic derangements, as demonstrated by previous robust data. Several factors [including genetics, inflammation, metabolic abnormalities, insulin resistance (IR), obesity, prenatal determinants, and gut–liver axis] have been found to be involved in MAFLD pathophysiology, but this tangled puzzle remains to be clearly understood. In particular, IR has been recognized as a key player in metabolic impairments development in children with fatty liver. On this ground, MAFLD definition focuses on the pathophysiological basis of the disease, by emphasizing the crucial role of metabolic impairments in this condition. Although primarily developed for adults, MAFLD diagnostic criteria have been recently updated with an age-appropriate definition for sex and age percentiles, because of the increasing attention to cardiometabolic risk in childhood. To date, accumulating evidence is available on the feasibility of MAFLD definition in clinical practice, but some data are still conflicting in highly selected populations. Considering the growing prevalence worldwide of fatty liver and its close relationship with metabolic dysfunction both in children and adults with subsequent increased cardiovascular risk, early strategies for MAFLD identification, treatment and prevention are needed. Novel therapeutic insights for MAFLD based on promising innovative biological techniques are also emerging. We aimed to summarize the most recent evidence in this intriguing research area both in children and adults.

Keywords: Metabolic; dysfunction; Fatty; Liver; Pathophysiology; Cardiovascular; Risk; Adults; Children

Core tip: Recently, experts have proposed to rename nonalcoholic fatty liver disease as metabolic-associated fatty liver disease (MAFLD), by emphasizing the close association of fatty liver with the metabolic milieu. Given that, a growing number of studies have tested the effectiveness of the new definition in adults and children, although evidence in this latter population is still limited. However, expanding knowledge about MAFLD and its pathophysiology is crucial for a better identification of subjects at greater metabolic risk.