Why NAFLD Is Now MASLD
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Nonalcoholic fatty liver disease (NAFLD) — a condition characterized by extra fat around the liver in the absence of heavy alcohol use — has officially been renamed as metabolic dysfunction–associated steatotic liver disease (MASLD).
Experts say the new nomenclature better reflects the various causes and contributing factors of the disease and avoids potentially stigmatizing language for those who have been diagnosed with it.
Everyday Health spoke with Jonathan Stine, MD, an associate professor of medicine and public health sciences at Penn State Health Milton S. Hershey Medical Center and an internationally recognized expert on liver disease, about the reasons behind the name change and what it means for those who live with the condition.
Everyday Health: Could you briefly go over some of the reasons for the name change of nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction–associated steatotic liver disease (MASLD)?
Jonathan Stine: The decision to change the name to metabolic dysfunction–associated steatotic liver disease (MASLD) stemmed from several key factors. One, there was dissatisfaction with the term “nonalcoholic,” as it didn’t accurately reflect the real-world disease states of many patients, especially those with overlapping risk factors. Additionally, the term “fatty” was considered stigmatizing. With this in mind, concerns were raised about the impact of the existing nomenclature on diagnosis, treatment, and research efforts, prompting a multistakeholder effort involving global experts to address these issues and develop a consensus to address these concerns. The aim of the international group was to create a name that better reflects the diverse etiologies and clinical manifestations of this leading cause of chronic liver disease worldwide while reducing stigma and improving inclusivity.
EH: When someone has MASLD, what is going on in the body and does the new name better encompass that?
JS: When an individual has MASLD, they have fatty infiltration in their liver due to metabolic dysfunction. This is commonly seen alongside other metabolic risk factors, including obesity, diabetes, dyslipidemia, and hypertension. The new name better encompasses the broader range of underlying metabolic factors contributing to the condition compared with the previous term of NAFLD. It reflects a more inclusive understanding of the disease beyond just the absence of alcohol consumption, providing a more accurate and comprehensive description of the condition and its associated metabolic disturbances.
EH: A major criticism of the term NAFLD is that it includes stigmatizing language like “fatty.” In your experience, have patients had strong reactions to the name NAFLD upon diagnosis?
JS: It’s understandable why the term “fatty” can evoke strong reactions from patients upon diagnosis. Many individuals feel stigmatized or ashamed by the language used to describe their condition, as it can carry negative connotations and perpetuate misconceptions about the causes and implications of the disease. Over my years of practice, I have had patients express feelings of frustration or even embarrassment when confronted with a label that seems to focus solely on weight or diet, overlooking the complex interplay of metabolic factors contributing to their liver health. As healthcare professionals, it’s important for us to listen to these concerns with empathy and understanding, recognizing the impact that language can have on patients’ perceptions of their illness and their willingness to seek support and treatment.
EH: Do you foresee any issues with communication around the name change among patients or providers? If so, how might this be overcome?
JS: Patients who have become accustomed to the term NAFLD may initially find it confusing or unfamiliar, leading to potential misunderstandings or difficulties in seeking information about their condition. Healthcare providers may also face challenges in adapting to the new terminology, particularly if they are accustomed to using the old terminology in their practice. To overcome these issues, proactive communication and education efforts will be essential. Patient advocacy groups, healthcare organizations, and professional societies such as the AASLD can play a key role in disseminating information about the name change and its rationale to both patients and providers.
EH: Currently, what are treatment options like for MASLD?
JS: Therapeutic options for MASLD are rapidly evolving — it is quite an exciting time to be in this field, and we anticipate having the first FDA-approved treatment available for our patients to use alongside leading a healthy life through exercising regularly, eating healthy, avoiding smoking, minimizing alcohol intake, and having good sleep quality.
Currently, there are several therapeutic options, and patients can be prescribed medications off-label, including vitamin E, drugs that are already approved to treat diabetes, such as pitoglitazone or some of the newer anti-obesity medications, such as semaglutide or tirzepatide. While we await FDA approval of a medication specifically indicated to treat MASLD, many patients choose to enroll in a clinical trial to get access to cutting-edge treatments, some of which target the main genes responsible for MASLD development.
Even when an FDA-approved medication is available, leading a healthy lifestyle will remain important, and individuals with MASLD should continue to eat a Mediterranean-informed diet high in whole grains, fruits, vegetables, nuts, olive oil, and lean proteins such as chicken or fish. Regular physical activity is also important, and those with MASLD should aim for 150 minutes each week of moderate-intensity activity such as walking or light cycling, or 75 minutes per week of vigorous-intensity activity, which could include jogging or running. Resistance training should be considered two days a week as well to augment the cardiovascular benefits of aerobic-based physical activity. Resistance training can be performed with simple low-impact exercises that use a person’s body weight for resistance, such as air squats or alternating lunges, and doesn’t necessarily require additional exercise equipment or even a gym membership.
EH: How might the new nomenclature affect research and potential new treatments for liver disease?
JS: One positive to come out of the nomenclature is a new field of research with MetALD (metabolic and alcohol related/associated liver disease) in which patients have both metabolic dysfunction and moderate alcohol consumption (4.9–12 ounces per week and 7.4–14.8 ounces per week for females and males, respectively) contributing to their steatotic liver disease. This is important because in the real world, there is often a blurring of the lines and individuals can have more than one risk factor for hepatic steatosis. Additionally, having predefined, agreed-upon metabolic-dysfunction criteria is important to ensure we as researchers are all studying the same population.
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