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. 2020 Aug 20;7:448. doi: 10.3389/fmed.2020.00448

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Copyright © 2020 Idalsoaga, Kulkarni, Mousa, Arrese and Arab.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Proposed algorithm to approach patients with liver steatosis. A staggered algorithm to approach patients with liver steatosis is shown. This algorithm considers alcohol intake and metabolic cofactors (obesity, T2DM, and MetS) and classifies patients in AAFLD alcohol-associated fatty liver disease (true ALD) if hazardous alcohol intake is present, AAFLD with metabolic component (predominant ALD but with metabolic cofactors), MAFLD metabolic associated fatty liver disease (NAFLD with alcohol consumption near zero), MAFLD with alcohol component (NAFLD but with alcohol consumption contributing to the disease process), and finally BAFLD both alcohol and metabolic associated fatty liver disease (patients with both NAFLD and ALD equally contributing or no possible to determine which predominates). Criteria to diagnose MAFLD are suggested in (72) in the main text.