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Definition of Metabolic Dysfunction: Shifting Goalposts

2023; Elsevier BV; Volume: 14; Issue: 2 Linguagem: Inglês

10.1016/j.jceh.2023.11.001

2213-3453

Prajna Anirvan, Chitta Ranjan Khatua, Manas Kumar Panigrahi, Shivaram Prasad Singh,

Diet, Metabolism, and Disease

This is war. The Crusades! Two opposing camps are sparring as to what exactly metabolic dysfunction is. The idea of renaming non-alcoholic fatty liver disease (NAFLD) to metabolic (dysfunction)-associated fatty liver disease (MAFLD) has opened a can of worms with regard to the definition of metabolic dysfunction [MD]. 1 Eslam M. Newsome P.N. Sarin S.K. et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020 Jul 1; 73: 202-209 Abstract Full Text Full Text PDF PubMed Scopus (2076) Google Scholar We had previously criticised the MAFLD criterion of MD and had shown that 33.9 % of healthy individuals without fatty liver satisfied two of seven parameters of MAFLD criterion although only 8.8 % had the metabolic syndrome (MS) as per ATP III criteria. 2 Singh S.P. Anirvan P. Sweeping 'metabolic dysfunction' off the front foot – deceived by the "wrong 'un": implications of dysmetabolism analysis in healthy subjects. J Clin Exp Hepatol. 2023 May 1; 13: 547-548 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ,3 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in AdultsExecutive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment panel III). JAMA. 2001 May 16; 285: 2486-2497 Crossref PubMed Google Scholar To make things worse, the Global NAFLD nomenclature consensus group have come up with the term 'metabolic dysfunction-associated steatotic liver disease (MASLD)' to replace NAFLD. 4 Rinella M.E. Lazarus J.V. Ratziu V. et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023 Nov 20; (Epub ahead of print.)https://doi.org/10.1097/HEP.0000000000000696 Crossref Google Scholar MD has been defined as presence of at least one of five cardiometabolic risk factors. This definition of MD too does not have any scientific basis. We, therefore, decided to re-evaluate the criterion for MD in a healthy cohort without fatty liver to see how this applied to healthy individuals.