Critical appraisal of metabolic dysfunction-associated steatotic liver disease: Implication of Janus-faced modernity

Abstract

The existing term non-alcoholic fatty liver disease (NAFLD) has raised substantial concerns due to its inherent disadvantages of using exclusionary diagnostic criteria and the stigmatizing word 'fatty.' Three pan-national liver associations set out to explore a new nomenclature to replace both NAFLD and its suggested alternative, metabolic (dysfunction)-associated fatty liver disease (MAFLD). They surveyed if a change in nomenclature and/or definition is favored and which nomenclature best communicates disease characteristics and increases awareness. In lieu of NAFLD/MAFLD, metabolic dysfunction-associated steatotic liver disease (MASLD) has been chosen, and an umbrella term, steatotic liver disease (SLD), encompassing the whole spectrum of liver disease, has been proposed. It has been suggested that cardiometabolic risk factors should be considered when categorizing SLD patients. Furthermore, a new subcategory, MASLD with increased alcohol intake (MetALD), casts light on a neglected group of patients with moderate or more alcohol consumption. The importance of metabolic dysfunction was acknowledged in this new nomenclature, but the precise contribution of metabolic dysfunction and alcohol consumption to the development and progression of SLD remains unclear. Herein, we review hepatologists' and endocrinologists' perspectives on the new nomenclature, along with its possible impact on clinical practice. Although it is premature to predict the settlement of the new nomenclature, this review may help build more evidence for a soft landing of it in the future.

Keywords: Metabolic dysfunction-associated steatotic liver disease; Metabolic-associated fatty liver disease; Nomenclature; Non-alcoholic fatty liver disease; Steatotic liver disease.

Figure 1.

MASLD diagnostic criteria. This figure was adapted from ‘A multi-society Delphi consensus statement on new fatty liver disease nomenclature’ and was modified in the interest of this review [12,13]. ALD, alcohol-associated liver disease; CMRF, cardiometabolic risk factor; DILI, drug-induced liver injury; MASLD, metabolic dysfunction-associated steatotic liver disease; SLD, steatotic liver disease.