Waiting for the changes after the adoption of steatotic liver disease

Abstract

Steatotic liver disease was suggested as an overarching term encompassing various etiologies of hepatic steatosis. Experts from multinational liver societies went through the Delphi process, including four rounds of surveys, and consented to adopt a new nomenclature and definition instead of the conventional nonalcoholic fatty liver disease (NAFLD). This was to improve the understanding of the patients and primary care physicians, with an explanation of the pathophysiology in the name of the disease. Also, it could minimize the stigmatization of patients by using the histological neutral term "steatosis" instead of "fatty". Herein, we will discuss the changes and continuity between the two nomenclatures, metabolic dysfunction-associated steatotic liver disease (MASLD) and NAFLD, as well as the challenges to MASLD which need to be addressed in future.

Keywords: Cardiometabolic risk factors; Fatty liver; Metabolic syndrome; Nonalcoholic fatty liver disease; Social stigma.

Figure 1.

The classification of Steatotic liver disease. Steatotic liver disease is diagnosed based on the presence of hepatic steatosis identified by imaging or liver biopsy. Metabolic dysfunction-associated steatotic liver disease or metabolic dysfunction-associated alcohol-related liver disease or other combination etiologies are diagnosed with the presence of cardiometabolic risk factors. Steatosis without cardiometabolic risk factors is further sub-classified into SLD with other specific etiology of hepatic steatosis or cryptogenic steatotic liver disease. Figure is modified from the recent consensus proposal [1]. MetALD, metabolic dysfunction-associated alcohol-related liver disease; SLD, steatotic liver disease.