Exploring the diagnostic accuracy of MAFLD, MASLD and metabolic syndrome in individuals with and without steatosis.

Abstract

Introduction and Objectives: The renaming of non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) marks a crucial milestone in the understanding of this complex disease, recognizing the role of metabolic dysfunction beyond the simple exclusion of excessive alcohol consumption. However, despite these advances, the redefined criteria have generated significant debate around their diagnostic accuracy. This debate centers on several key issues, such as the breadth of the criteria, their applicability in different populations, and the risk of overdiagnosis. The aim of this study is to explore the application of the MAFLD, MASLD and metabolic syndrome criteria in the identification and categorization of individuals with and without hepatic steatosis, with the objective of determining the suitability of both criteria for clinical use. Materials and Patients: A retrospective study was conducted with 600 individuals who attended routine check-ups at Medica Sur Clinic and Foundation, Mexico City, Mexico. Data were collected from clinical evaluations, imaging studies and laboratory tests. The diagnosis of hepatic steatosis was made using vibration-controlled transient elastography. The diagnosis of MAFLD, MASLD and metabolic syndrome was made according to the criteria established for each definition. Results: Among individuals with hepatic steatosis, prevalence rates were 89.4% for MASLD, 81.5% for MAFLD (81.5%), and 32.8% for metabolic syndrome. Interestingly, a higher proportion of individuals without hepatic steatosis met MASLD criteria (53.2%) compared with MAFLD (28.1) and MetS (8.2%) criteria. Sensitivity and specificity analysis revealed a balanced performance of MAFLD, whereas MASLD showed higher sensitivity but lower specificity. Sensitivity and specificity analysis revealed a balanced performance of MAFLD, whereas MASLD showed slightly higher sensitivity but much lower specificity. When assessing the metabolic risk profile, individuals with MAFLD and metabolic syndrome were found to be at higher risk than those with MASLD. Conclusions: MAFLD emerges as a balanced diagnostic framework, offering reliable sensitivity and specificity. Although MASLD exhibits higher sensitivity, its lower specificity