Liver diseases are being renamed: an end to stigmatisation?

The terms non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are misleading for some experts, with inaccurate associations leading to stigmas.

What is the new terminology for liver diseases?

Fatty liver disease now comes under the umbrella term steatotic liver disease or SLD.
Non-alcoholic fatty liver disease becomes metabolic dysfunction-associated steatotic liver disease or MASLD.
Non-alcoholic steatohepatitis is renamed metabolic dysfunction-associated steatohepatitis or MASH.
Patients with MASLD who consume larger amounts of alcohol now suffer from MetALD by definition.
Cryptogenic SLD is present when the cause of the liver disease is unclear.

About the previous terms

The previous nomenclature was considered by some experts to be too stigmatising, as it contained the adjectives alcoholic and fatty. However, the pathophysiological inaccuracy in the old names is at least as relevant. It was therefore time for a revised nomenclature, according to the experts. A consortium of liver specialists, patient associations and professional societies therefore came together and gave fatty liver disease new names.

What are they called now?

The aim was to name the diseases as precisely as possible and also to address the relevant pathophysiology.

The generic term for fatty liver disease is now steatotic liver disease or SLD.
Non-alcoholic fatty liver disease has been renamed metabolic dysfunction associated steatotic liver disease or MASLD.
Patients who consume between 140g and 350g of alcohol per week suffer from the MetALD subtype.
Non-alcoholic steatohepatitis is now referred to as metabolic dysfunction associated steatotic hepatitis or MASH.
If the origin of the disease is unclear, it is now referred to as cryptogenic SLD.

Why are the new names better?

The new nomenclature is more orientated towards the underlying cause of the disease than its predecessor. In addition, stigmatising adjectives are avoided and removed from the disease names. The experts hope that this will enable a more precise classification of the disease.

A clearer view of disease development

The renaming marks the beginning of a new era for fatty liver disease, at least formally. Greater attention is now being paid to the pathogenesis of the disease, paving the way for a more precise nomenclature. Patients will also be less stigmatised by the diagnosis, according to the experts.

Source

Rinella ME, et al: NAFLD Nomenclature consensus group. A multi-society Delphi consensus statement on new fatty liver disease nomenclature.Â Ann Hepatol. 2023 Jun 24:101133. doi: 10.1016/j.aohep.2023.101133. Epub ahead of print. PMID: 37364816.