From the Guidelines
The new nomenclature for non-alcoholic fatty liver disease (NAFLD) is metabolic dysfunction-associated steatotic liver disease (MASLD). This change was implemented to better reflect the underlying metabolic dysfunction that drives the disease process rather than defining it by what it is not (non-alcoholic) 1. For patients with evidence of liver inflammation and damage, the term metabolic dysfunction-associated steatohepatitis (MASH) replaces the previous term non-alcoholic steatohepatitis (NASH) 1. This updated terminology acknowledges that the condition is primarily linked to metabolic risk factors such as obesity, type 2 diabetes, dyslipidemia, and insulin resistance.
Key Points
- The spectrum of MASLD includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and MASH-related hepatocellular carcinoma (HCC) 1.
- Case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes, and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes or obesity with additional metabolic risk factor(s) 1.
- A stepwise approach using blood-based scores (such as the fibrosis-4 index [FIB-4]) and, sequentially, imaging techniques (such as transient elastography) is suitable to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes 1.
- In adults with MASLD, lifestyle modification—including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption—as well as optimal management of comorbidities—including use of incretin-based therapies (e.g., semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated—is advised 1.
Management
- Bariatric surgery is also an option in individuals with MASLD and obesity 1.
- If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) should be considered for a MASH-targeted treatment with resmetirom, which demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile 1.
- No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage 1.
- Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis 1.
From the Research
New Nomenclature for Fatty Liver
The new nomenclature for non-alcoholic fatty liver disease (NAFLD) is Metabolic-associated fatty liver disease (MAFLD) or Metabolic dysfunction-associated steatotic liver disease (MASLD), which replaces the outdated term NAFLD to provide a more accurate description of fatty liver disease associated with metabolic dysfunction 2, 3, 4, 5, 6.
Key Features of the New Nomenclature
- MAFLD or MASLD is characterized by the presence of hepatic steatosis and at least one cardiometabolic risk factor, with no other apparent cause 2, 4, 5.
- The new nomenclature aims to improve diagnostic criteria and tailored treatment strategies for the disease 2, 3.
- MAFLD or MASLD has been shown to have superior utility in identifying patients at high risk for metabolic dysfunction and hepatic and extra-hepatic complications compared to NAFLD 3, 6.
Implications of the New Nomenclature
- The change in nomenclature has improved disease awareness among patients and physicians 6.
- The new nomenclature has stimulated enthusiasm among researchers, resulting in a large number of publications over the past two years 3.
- Further research is needed to develop more accurate diagnostic tools for advanced fibrosis in MAFLD or MASLD and to explore the underlying mechanisms linking MAFLD or MASLD with other conditions 2, 4, 5.