Evolution of NAFLD terminology

The field of medicine is constantly evolving, and so are the terms used to describe various conditions and diseases. Establishing more precise naming conventions can enhance clinical language. The resulting clarity can help doctors better understand the condition itself and improve diagnosis, treatment and overall patient care.

Have you ever wondered why the terms “non-alcoholic” and “fatty” are used to describe liver diseases that affect millions of people around the world? Well, the terminology surrounding non-alcoholic fatty liver disease (NAFLD) is changing, and for good reason.

The term “nonalcoholic steatohepatitis” was coined in 1980 to describe liver disease associated with overweight or obesity, but it does not accurately describe the cause of the disease, its histologic features, and may carry a stigma. “Fat.” Despite the existence of shared pathophysiological pathways, individuals at risk for NAFLD who drink above non-alcoholic thresholds are excluded from the current terminology. In addition, various scoring systems are used to classify the severity of steatosis, disease activity, and fibrosis. Given the complexity of the condition, it is clear to researchers and clinicians that current terminology does not meet the need to accurately describe metabolic dysfunction.

Recently published in Journal of Hepatology A consensus statement on the adoption of new terminology for the treatment of this liver disease is described. Growing dissatisfaction with existing nomenclature and diagnostic standards for NAFLD has prompted the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), and many healthcare experts from the liver disease community to push for the development of a new NAFLD nomenclature. Change.

Experts advocate for more accurate and comprehensive terminology to reflect the various subtypes and severities of the disease, adding that it is crucial to move beyond simple labels of “non-alcoholic” and “fat.” Doing so, they believe, could improve diagnosis, treatment and public awareness of this major health problem.

This multi-society study used the Delphi method, which involved multiple rounds of surveys and discussions with a diverse panel of experts, practitioners, and patient advocates. The goal is to develop a unified global approach to naming and defining these liver diseases to improve disease awareness, policy changes, and access to care.

After aggregating all respondents and surveys, we decided that fatty liver disease (SLD) should be an umbrella term for the many causes of steatosis, the medical term for the accumulation of excess fat in liver cells. Participants overwhelmingly agreed with relabeling NAFLD as metabolic dysfunction-associated steatosis liver disease (MASLD), which includes hepatic steatosis and cardiometabolic risk factors. To accurately define patients with higher than normal levels of alcohol consumption, MetALD was chosen. This term emphasizes the metabolic overlap between patients with different alcohol status and maintains continuity with MASLD rather than alcohol-associated liver disease (ALD). The inflammation and cell damage associated with NASH is now known as metabolic-associated steatohepatitis, or MASH.

This consensus statement provides valuable insights into current challenges and dissatisfactions with fatty liver disease nomenclature and disease definition. The proposed modifications and new nomenclature have the potential to increase disease awareness, policy changes, and access to care for individuals affected by these liver diseases. The authors hope that this policy change will accelerate the development of drugs and biomarkers so that these patients can be optimally treated.