MAFLD burden on the Spanish National Health System. A call to action.

We have read the editorial by Crespo et al on the metabolic associated liver disease (MAFLD) foreseeable burden on the Spanish National Health System over the next years. Between 0.35-0.4% of Spanish population has cirrhosis and more than one million people has significant fibrosis, assessed by ET ≥ 9 kPa. Compared with general population, patients with cirrhosis have more comorbidities and use healthcare resources more frequently. Recent data show a decrease of 24% in hospitalization due to cirrhosis during the period 2005-2014 in our country. These data predate the availability of direct antiviral agents against HCV. A 20% reduction of cirrhosis-related mortality during the period 2006-2018 was observed, as with other Southern European countries. This decline reflects a reduction of alcohol consumption in the last decades. More recently, 90% of patients with significant liver fibrosis were negative for HCV or HBV, did not consume harmful amounts of alcohol and showed components of metabolic syndrome thereby suggesting that MAFLD is the current leading cause of liver fibrosis in Spain. Some studies found that disadvantaged areas in the Community of Madrid had higher liver-related mortality, highlighting that lower income is another socioeconomic determinant of chronic liver disease.