The medical community is witnessing a pivotal shift in how liver diseases are classified, notably the renaming of Non-Alcoholic Fatty Liver Disease (NAFLD) to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). This change more accurately reflects the disease’s underlying causes, emphasizing its strong link to metabolic dysfunction rather than focusing on what it is not.

The renaming came out of a modified Delphi process led by three pan-national liver associations, involving 236 panellists from 56 countries. Seventy-four percent of respondents felt the existing nomenclature was sufficiently flawed to warrant a change, and the terms “nonalcoholic” and “fatty” were considered stigmatising by 61% and 66% of respondents respectively.

Why the Change?

NAFLD has traditionally described liver conditions in individuals without significant alcohol consumption. However, the term “non-alcoholic” has led to confusion, as it focuses on what the disease is not, rather than highlighting its actual metabolic drivers. The new terminology, MASLD, shifts the focus to the key metabolic factors like insulin resistance, obesity, and lipid abnormalities that contribute to liver steatosis. This clarification aligns MASLD more closely with metabolic syndrome, linking it to related conditions such as type 2 diabetes and cardiovascular disease.

The consensus statement also changed the definition to require the presence of at least one of five cardiometabolic risk factors. Patients with steatosis but no metabolic parameters and no known cause are now classified as having cryptogenic steatotic liver disease, and a separate category, MetALD, describes those who meet MASLD criteria while consuming higher amounts of alcohol.

Reduction of Stigma

The term NAFLD carries potential stigma, often leading to mistaken assumptions about alcohol use. MASLD avoids these connotations, reducing bias in patient care and focusing on the true nature of the disease, which is metabolic health. This shift in language helps patients feel more understood and supported, reframing their diagnosis in a more positive light.

Improved Patient Communication

MASLD allows healthcare providers to better explain the condition, emphasizing the importance of managing metabolic risk factors through diet, exercise, and medical interventions. This clear communication empowers patients to take proactive steps in their treatment, reinforcing the connection between liver health and overall metabolic wellness.

Alignment with Current Research

The renaming also aligns with the latest research, which highlights the role of metabolic dysfunction in liver disease. This integrated approach supports the development of targeted therapies and comprehensive treatment strategies that address the root causes of MASLD.

Implications for Diagnosis and Treatment

The transition to MASLD has practical implications:

• Diagnosis: Clinicians are encouraged to adopt the new terminology in assessments.
• Treatment: A continued focus on metabolic health, with increased emphasis on holistic management.
• Research: Future studies will likely delve deeper into the metabolic aspects of MASLD, paving the way for more targeted interventions.

Dietary strategies are one of the most studied levers here. We cover the evidence on fasting protocols in MASLD, including alternate-day fasting and the 5:2 approach, in our article on the basics of fasting from a functional medicine perspective.

Takeaways

The shift from NAFLD to MASLD marks significant progress in hepatology, underscoring the central role of metabolic health in liver disease. This change not only clarifies the condition but also reduces stigma, aligns with scientific research, and ultimately enhances patient care.

Interested in learning more? Enroll in our comprehensive MASLD course, designed specifically for healthcare professionals looking to deepen their understanding of metabolic dysfunction-associated liver disease. Explore the latest research, diagnostic strategies, and treatment protocols to enhance your clinical practice. Click here to sign up for the course.

-Carey Kunz, ND, IFMCP

Director of Education at FMP Essentials

References

1. Rinella ME, Lazarus JV, Ratziu V, et al.; NAFLD Nomenclature Consensus Group. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556. doi:10.1016/j.jhep.2023.06.003. PMID: 37364790.
2. Rinella ME, Lazarus JV, Ratziu V, et al.; NAFLD Nomenclature Consensus Group. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. Co-published with the Journal of Hepatology statement above.