{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:38:24Z","timestamp":1780583904902,"version":"3.54.1"},"reference-count":89,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Background: The most common cause of chronic liver disease is now known to be non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic-associated fatty liver disease (MAFLD). This review aims to synthesize current evidence on the pathophysiology and clinical implications of nephrological, pulmonary, and dermatological manifestations among NAFLD\/MAFLD patients. In order to find safe and efficient treatments, NAFLD\/MAFLD has emerged as a primary concern for hepatologists worldwide. Methods: We conducted a comprehensive review of the literature from major databases, focusing on studies that evaluated the extrahepatic manifestations of NAFLD\/MAFLD. Emphasis was placed on identifying pathophysiological mechanisms and assessing their clinical impact on renal, pulmonary, and dermatological systems. Results: Recent developments in the management of chronic viral hepatitis have lowered the mortality rate associated with chronic liver disease. However, the prevalence of NAFLD\/MAFLD continues to rise, making chronic liver disease a significant health concern for the future. An increasing percentage of patients on liver transplant waiting lists now have cirrhosis and hepatocellular carcinoma due to non-alcoholic liver disease. Furthermore, the incidence and prevalence of chronic kidney disease have surged, linking NAFLD\/MAFLD to higher morbidity, mortality, and healthcare costs. Conclusions: NAFLD\/MAFLD is underdiagnosed and underappreciated, yet its incidence is rapidly increasing, raising concerns about a potential global epidemic. Given its multisystemic impact\u2014extending to renal, pulmonary, and dermatological complications\u2014it is crucial to develop interdisciplinary strategies for early detection and effective management of the disease.<\/jats:p>","DOI":"10.3390\/metabo15040272","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T06:18:36Z","timestamp":1744611516000},"page":"272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Nephrological, Pulmonary, and Dermatological Complications in the Context of MAFLD\/NAFLD: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7398-5689","authenticated-orcid":false,"given":"Vlad","family":"P\u0103dureanu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6065-2782","authenticated-orcid":false,"given":"Dalia","family":"Dop","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucre\u021biu","family":"Radu","sequence":"additional","affiliation":[{"name":"Department of Hygiene, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3990-6483","authenticated-orcid":false,"given":"Dumitru","family":"R\u0103dulescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"P\u0103dureanu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa Floriana Vasilica","family":"P\u00eer\u0219coveanu","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Cosmin","family":"Caragea","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1136\/gutjnl-2020-320622","article-title":"NAFLD and increased risk of cardiovascular disease: Clinical associations, pathophysiological mechanisms and pharmacological implications","volume":"69","author":"Targher","year":"2020","journal-title":"Gut"},{"key":"ref_2","first-page":"1137","article-title":"Deciphering the NAFLD\u2013NASH puzzle in obesity-related cardiometabolic risk","volume":"1842","author":"Musso","year":"2014","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1136\/gutjnl-2015-309265","article-title":"Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: A prospective cohort study","volume":"65","author":"Kwok","year":"2016","journal-title":"Gut."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD: A multisystem disease","volume":"62","author":"Byrne","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.jhep.2017.08.024","article-title":"Development of chronic kidney disease in patients with non-alcoholic fatty liver disease: A cohort study","volume":"67","author":"Sinn","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1038\/ki.2011.368","article-title":"The contribution of chronic kidney disease to the global burden of major noncommunicable diseases","volume":"80","author":"Couser","year":"2011","journal-title":"Kidney Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jhep.2020.01.013","article-title":"NAFLD as a driver of chronic kidney disease","volume":"72","author":"Byrne","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/liv.13992","article-title":"Chronic kidney disease is independently associated with increased mortality in patients with non-alcoholic fatty liver disease","volume":"39","author":"Paik","year":"2019","journal-title":"Liver Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.aohep.2019.07.013","article-title":"Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the hepatologist should know?","volume":"19","author":"Kiapidou","year":"2020","journal-title":"Ann. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/nrneph.2017.16","article-title":"Non-alcoholic fatty liver disease: An emerging driving force in chronic kidney disease","volume":"13","author":"Targher","year":"2017","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.2215\/CJN.05050610","article-title":"Relationship between kidney function and liver histology in subjects with nonalcoholic steatohepatitis","volume":"5","author":"Targher","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1159\/000343885","article-title":"Association between non-alcoholic liver disease and chronic kidney disease: An ultrasound analysis from NHANES 1988\u20131994","volume":"36","author":"Sirota","year":"2012","journal-title":"Am. J. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/1469-0691.12140","article-title":"Gut microbiota and non-alcoholic fatty liver disease: New insights","volume":"19","author":"Gaborit","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","first-page":"69","article-title":"Interactions of lipid and glucose metabolism: RAAS, beta-cell function, and NAFLD","volume":"16","author":"Musso","year":"2010","journal-title":"Trends Mol. Med."},{"key":"ref_15","first-page":"463","article-title":"Association of obstructive sleep apnea with the presence and severity of nonalcoholic fatty liver disease","volume":"57","author":"Musso","year":"2013","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1038\/ki.2013.243","article-title":"Comments on KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"84","author":"Andrassy","year":"2013","journal-title":"Kidney Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"168","DOI":"10.5009\/gnl19069","article-title":"Extrahepatic manifestations of nonalcoholic fatty liver disease","volume":"14","author":"Li","year":"2020","journal-title":"Gut Liver"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Sesti, G., Fiorentino, T.V., Arturi, F., Perticone, M., Sciacqua, A., and Perticone, F. (2014). Association between noninvasive fibrosis markers and chronic kidney disease among adults with nonalcoholic fatty liver disease. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088569"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Jang, H.R., Kang, D., Sinn, D.H., Gu, S., Cho, S.J., Lee, J.E., Huh, W., Paik, S.W., Ryu, S., and Chang, Y. (2018). Nonalcoholic fatty liver disease accelerates kidney function decline in patients with chronic kidney disease: A cohort study. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-23014-0"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.metabol.2017.11.003","article-title":"Nonalcoholic fatty liver disease increases risk of incident chronic kidney disease: A systematic review and meta-analysis","volume":"79","author":"Mantovani","year":"2018","journal-title":"Metabolism"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.metabol.2007.11.022","article-title":"Nonalcoholic fatty liver disease predicts chronic kidney disease in nonhypertensive and nondiabetic Korean men","volume":"57","author":"Chang","year":"2008","journal-title":"Metabolism"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhang, M., Lin, S., Wang, M., Huang, J.-F., Liu, S.-Y., Wu, S.-M., Zhang, H.-Y., Wu, Z.-M., Liu, W.-Y., and Zhang, D.-C. (2020). Association between NAFLD and risk of prevalent chronic kidney disease: Why there is a difference between east and west?. BMC Gastroenterol., 30.","DOI":"10.21203\/rs.2.21313\/v2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11901-016-0295-9","article-title":"Extrahepatic manifestations of nonalcoholic fatty liver disease","volume":"15","author":"VanWagner","year":"2016","journal-title":"Curr. Hepatol. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1146\/annurev.med.60.101107.134820","article-title":"Emerging molecular targets for the treatment of nonalcoholic fatty liver disease","volume":"61","author":"Musso","year":"2010","journal-title":"Annu. Rev. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.2337\/dc15-1182","article-title":"Fatty liver and chronic kidney disease: Novel mechanistic insights and therapeutic opportunities","volume":"39","author":"Musso","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.gtc.2019.10.002","article-title":"Extrahepatic manifestations of non-alcoholic fatty liver disease","volume":"49","author":"Wattacheril","year":"2020","journal-title":"Gastroenterol. Clin. North Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1002\/hep.26717","article-title":"Extrahepatic complications of nonalcoholic fatty liver disease","volume":"59","author":"Armstrong","year":"2014","journal-title":"Hepatology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1002\/hep.30429","article-title":"Modulation of Insulin Resistance in Nonalcoholic Fatty Liver Disease","volume":"70","author":"Khan","year":"2019","journal-title":"Hepatology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1016\/j.dsx.2020.09.026","article-title":"Pathophysiological mechanisms underlying MAFLD","volume":"14","author":"Kuchay","year":"2020","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1378\/chest.13-0938","article-title":"Nonalcoholic fatty liver disease, nocturnal hypoxia, and endothelial function in patients with sleep apnea","volume":"145","author":"Minville","year":"2014","journal-title":"Chest"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jceh.2019.07.008","article-title":"Extra-hepatic manifestations of nonalcoholic fatty liver disease: A review","volume":"10","author":"Tariq","year":"2020","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.pop.2009.01.009","article-title":"Comorbidities of obesity","volume":"36","author":"Schelbert","year":"2009","journal-title":"Prim. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s12072-015-9615-3","article-title":"Obstructive sleep apnea is an important predictor of hepatic fibrosis in patients with non-alcoholic fatty liver disease in a tertiary care center","volume":"9","author":"Agrawal","year":"2015","journal-title":"Hepatol. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1002\/hep.20725","article-title":"Chronic liver injury during obstructive sleep apnea","volume":"41","author":"Tanne","year":"2005","journal-title":"Hepatology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s11695-007-9085-3","article-title":"Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: A prospective study","volume":"17","author":"Jouet","year":"2007","journal-title":"Obes. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jhep.2011.04.022","article-title":"Chronic intermittent hypoxia is a major trigger for non-alcoholic fatty liver disease in morbid obese","volume":"56","author":"Minville","year":"2012","journal-title":"J. Hepatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/obr.12020","article-title":"Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease: A systematic review and meta-analysis","volume":"14","author":"Musso","year":"2013","journal-title":"Obes. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/lt.25367","article-title":"Association of pre-transplant renal function with liver graft and patient survival after liver transplantation in patients with nonalcoholic steatohepatitis","volume":"25","author":"Molnar","year":"2019","journal-title":"Liver Transpl."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1164\/ajrccm\/144.3_Pt_1.494","article-title":"Effect of weight loss on upper airway collapsibility in obstructive sleep apnea","volume":"144","author":"Schwartz","year":"1991","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"850","DOI":"10.7326\/0003-4819-103-6-850","article-title":"Weight loss in mildly to moderately obese patients with obstructive sleep apnea","volume":"103","author":"Smith","year":"1985","journal-title":"Ann. Intern. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1038\/nrcardio.2012.141","article-title":"Mechanisms of cardiac dysfunction in obstructive sleep apnea","volume":"9","author":"Baguet","year":"2012","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.beem.2010.08.011","article-title":"Metabolic consequences of intermittent hypoxia: Relevance to obstructive sleep apnea","volume":"24","author":"Drager","year":"2010","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1210\/jcem.85.3.6484","article-title":"Sleep apnea and daytime sleepiness and fatigue: Relation to visceral obesity, insulin resistance, and hypercytokinemia","volume":"85","author":"Vgontzas","year":"2000","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.jaad.2013.10.044","article-title":"Psoriasis is independently associated with nonalcoholic fatty liver disease in patients 55 years old or older: Results from a population-based study","volume":"70","author":"Koehler","year":"2014","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/hep.24706","article-title":"Serum ferritin is an independent predictor of histologic severity and advanced fibrosis in patients with nonalcoholic fatty liver disease","volume":"55","author":"Kowdley","year":"2012","journal-title":"Hepatology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1468-3083.2010.03841.x","article-title":"Psoriasis and non-alcoholic fatty liver disease","volume":"25","author":"Wenk","year":"2011","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s00535-012-0678-9","article-title":"The effect of etanercept on hepatic fibrosis risk in patients with non-alcoholic fatty liver disease, metabolic syndrome, and psoriasis","volume":"48","author":"Campanati","year":"2013","journal-title":"J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/jgh.12656","article-title":"PNPLA3 gene polymorphism and response to lifestyle modification in patients with non-alcoholic fatty liver disease","volume":"30","author":"Shen","year":"2015","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1053\/j.gastro.2012.04.001","article-title":"American Gastroenterological Association; American Association for the Study of Liver Diseases et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology","volume":"142","author":"Chalasani","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1055\/s-0029-1240928","article-title":"A European evidence based guideline for the prevention of type 2 diabetes","volume":"42","author":"Paulweber","year":"2010","journal-title":"Horm. Metab. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/ijcp.12114","article-title":"Taking small steps towards targets: Perspectives for clinical practice in diabetes, cardiometabolic disorders and beyond","volume":"67","author":"Golay","year":"2013","journal-title":"Int. J. Clin. Pract."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"104","DOI":"10.3945\/ajcn.111.012369","article-title":"Genetic variation in PNPLA3 (adiponutrin) confers sensitivity to weight loss-induced decrease in liver fat in humans","volume":"94","author":"Sevastianova","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.jhep.2013.06.027","article-title":"Weight loss allows the dissection of the interaction between abdominal fat and PNPLA3 (adiponutrin) in the liver damage of obese children","volume":"59","author":"Marzuillo","year":"2013","journal-title":"J. Hepatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"S102","DOI":"10.1161\/01.cir.0000437739.71477.ee","article-title":"2013 AHA\/ACC\/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and The Obesity Society","volume":"129","author":"Jensen","year":"2014","journal-title":"Circulation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.jhep.2007.06.020","article-title":"Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): A population based study","volume":"47","author":"Goldsmith","year":"2007","journal-title":"J. Hepatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.3892\/etm.2021.10790","article-title":"Non-alcoholic fatty liver disease and hematologic manifestations (Review)","volume":"22","author":"Dop","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.4254\/wjh.v7.i24.2522","article-title":"Dietary approach in the treatment of nonalcoholic fatty liver disease","volume":"7","author":"Ferolla","year":"2015","journal-title":"World J. Hepatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1155\/2008\/810961","article-title":"Soft drink consumption linked with fatty liver in the absence of traditional risk factors","volume":"22","author":"Assy","year":"2008","journal-title":"Can. J. Gastroenterol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/hep.22350","article-title":"Visceral fat: A key mediator of steatohepatitis in metabolic liver disease","volume":"48","author":"Milner","year":"2008","journal-title":"Hepatology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1002\/hep.22525","article-title":"Role of leisure-time physical activity in nonalcoholic fatty liver disease: A population-based study","volume":"48","author":"Goldsmith","year":"2008","journal-title":"Hepatology"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/MOL.0b013e32833ea912","article-title":"Exercise and fat accumulation in the human liver","volume":"21","author":"Magkos","year":"2010","journal-title":"Curr. Opin. Lipidol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1111\/liv.12552","article-title":"Role of physical activity in nonalcoholic fatty liver disease in terms of visceral obesity and insulin resistance","volume":"35","author":"Kwak","year":"2015","journal-title":"Liver Int."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/liv.13332","article-title":"The preventive effect of sustained physical activity on incident nonalcoholic fatty liver disease","volume":"37","author":"Kwak","year":"2017","journal-title":"Liver Int."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Boccatonda, A., Andreetto, L., D\u2019Ardes, D., Cocco, G., Rossi, I., Vicari, S., Schiavone, C., Cipollone, F., and Guagnano, M.T. (2023). From NAFLD to MAFLD: Definition, Pathophysiological Basis and Cardiovascular Implications. Biomedicines, 11.","DOI":"10.3390\/biomedicines11030883"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.eprac.2022.03.016","article-title":"Metabolic Associated Fatty Liver Disease Increases the Risk of Systemic Complications and Mortality. A Meta-Analysis and Systematic Review of 12\u2009620\u2009736 Individuals","volume":"28","author":"Quek","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2939","DOI":"10.1111\/liv.16075","article-title":"Clinical outcomes of MAFLD versus NAFLD: A meta-analysis of observational studies","volume":"44","author":"Pennisi","year":"2024","journal-title":"Liver Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"9084","DOI":"10.3390\/cimb45110570","article-title":"The Interconnection between Hepatic Insulin Resistance and Metabolic Dysfunction-Associated Steatotic Liver Disease\u2014The transition from an adipocentric to liver-centric approach","volume":"45","author":"Macut","year":"2023","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Mendez-Sanchez, N., Cruz-Ramon, V.C., Ramirez-Perez, O.L., Hwang, J.P., Barranco-Fragoso, B., and Cordova-Gallardo, J. (2018). New Aspects of Lipotoxicity in Nonalcoholic Steatohepatitis. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19072034"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Francisco, V., Sanz, M.J., Real, J.T., Marques, P., Capuozzo, M., Ait Eldjoudi, D., and Gualillo, O. (2022). Adipokines in Non-Alcoholic Fatty Liver Disease: Are We on the Road toward New Biomarkers and Therapeutic Targets?. Biology, 11.","DOI":"10.3390\/biology11081237"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Petrescu, M., Vlaicu, S.I., Cium\u0103rnean, L., Milaciu, M.V., M\u0103rginean, C., Florea, M., Vesa, \u0218.C., and Popa, M. (2022). Chronic Inflammation\u2014A Link between Nonalcoholic Fatty Liver Disease (NAFLD) and Dysfunctional Adipose Tissue. Medicina, 58.","DOI":"10.3390\/medicina58050641"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"167","DOI":"10.34172\/mejdd.2022.270","article-title":"Non-alcoholic Fatty Liver Disease and Steatohepatitis: Risk Factors and Pathophysiology","volume":"14","author":"Akter","year":"2022","journal-title":"Middle East J. Dig. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"329","DOI":"10.14218\/JCTH.2021.00178","article-title":"Metabolic-associated Fatty Liver Disease (MAFLD): A Multi-systemic Disease Beyond the Liver","volume":"10","author":"Kaya","year":"2022","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_74","first-page":"e18201","article-title":"Decoding the Pathophysiology of Non-alcoholic Fatty Liver Disease Progressing to Non-alcoholic Steatohepatitis: A Systematic Review","volume":"13","author":"Yaqub","year":"2021","journal-title":"Cureus."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Yamaguchi, T., Yoshida, K., Murata, M., Suwa, K., Tsuneyama, K., Matsuzaki, K., and Naganuma, M. (2022). Smad3 Phospho-Isoform Signaling in Nonalcoholic Steatohepatitis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23116270"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.3350\/cmh.2022.0367","article-title":"MAFLD: How is it different from NAFLD?","volume":"29","author":"Gofton","year":"2023","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_77","first-page":"30","article-title":"From NAFLD to MAFLD and MASLD: A tale of alcohol, stigma and metabolic dysfunction","volume":"4","author":"Ciardullo","year":"2024","journal-title":"Metab. Target Organ Damage"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jceh.2022.12.011","article-title":"INASL-SAASL Consensus Statements on NAFLD Name Change to MAFLD","volume":"13","author":"Singh","year":"2023","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_79","first-page":"e933860","article-title":"Editorial: International Consensus Recommendations to Replace the Terminology of Non-Alcoholic Fatty Liver Disease (NAFLD) with Metabolic-Associated Fatty Liver Disease (MAFLD)","volume":"27","year":"2021","journal-title":"Med. Sci. Monit."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"101512","DOI":"10.1016\/j.aohep.2024.101512","article-title":"MAFLD criteria are better than MASLD criteria at predicting the risk of chronic kidney disease","volume":"29","author":"Pan","year":"2024","journal-title":"Ann. Hepatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1080\/0886022X.2022.2144373","article-title":"Association of metabolic dysfunction-associated fatty liver disease with chronic kidney disease: A Chinese population-based study","volume":"44","author":"Hu","year":"2022","journal-title":"Ren. Fail."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e333","DOI":"10.1097\/01.hjh.0000916128.52225.70","article-title":"MAFLD predicts new onset of chronic kidney disease better than does fatty liver or NAFLD","volume":"41","author":"Kawasoe","year":"2023","journal-title":"J. Hypertens."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Nasreldin, M.A., Essam, S., Ahmed, M., Alnokeety, M., Elsalamony, T., Noor, A., and Saeed, I. (2022). The Entanglement between Metabolic Associated Non- Alcoholic Fatty liver Disease and Chronic Kidney Disease Progression is more than just a Strong Correlation. A Narrative Review. Int. J. Clin. Nephrol., 1.","DOI":"10.31579\/2834-5142\/036"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5414\/CNP71244","article-title":"Prevalence of chronic kidney disease: A systematic review and meta-analysis","volume":"71","author":"Anothaisintawee","year":"2009","journal-title":"Clin. Nephrol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"20420188221145650","DOI":"10.1177\/20420188221145650","article-title":"Screening for MAFLD: Who, when and how?","volume":"14","author":"Pal","year":"2023","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12944-020-01288-6","article-title":"Association between nonalcoholic fatty liver disease and extrahepatic cancers: A systematic review and meta-analysis","volume":"19","author":"Liu","year":"2020","journal-title":"Lipids Health Dis."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2147\/NSS.S398971","article-title":"Association Between Metabolic-Associated Fatty Liver Disease and Obstructive Sleep Apnea: A Cross-Sectional Study","volume":"15","author":"Huang","year":"2023","journal-title":"Nat. Sci. Sleep"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.smrv.2016.02.007","article-title":"Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: A systematic review","volume":"32","author":"Shawon","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_89","first-page":"67","article-title":"Chronic Obstructive Pulmonary Disease (COPD)","volume":"10","author":"Prasad","year":"2023","journal-title":"Int. J. Pharm. Res. Technol."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/15\/4\/272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:10Z","timestamp":1760030050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/15\/4\/272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":89,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["metabo15040272"],"URL":"https:\/\/doi.org\/10.3390\/metabo15040272","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}