From the Guidelines
The term Metabolic Associated Steatohepatitis Liver Disease (MASLD) was first used in 2024 by the European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) in their clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) published in the Journal of Hepatology and Diabetologia 1. This change in terminology was made to better reflect the underlying metabolic dysfunction associated with the condition and to remove the negative connotation of the "non-alcoholic" prefix, which was considered stigmatizing for patients. The new terminology acknowledges that metabolic risk factors such as obesity, type 2 diabetes, dyslipidemia, and hypertension play central roles in the development and progression of this liver disease. Similarly, "Non-Alcoholic Steatohepatitis" (NASH) was renamed to "Metabolic Associated Steatohepatitis" (MASH) to maintain consistency in the nomenclature and better reflect the pathophysiology of the more severe, inflammatory form of the disease. Some key points to consider when managing MASLD include:
- The presence of at least one cardiometabolic risk factor is required for the diagnosis of MASLD 1
- 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 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 (T2D) or obesity with additional metabolic risk factor(s) 1
- Lifestyle modification, including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption, as well as optimal management of comorbidities, is advised for adults with MASLD 1.
From the Research
Definition and First Use of MASLD
- The term Metabolic Associated Steatohepatitis Liver Disease (MASLD) is used to describe a condition of heterogeneous metabolic risk factors, mechanisms, and comorbidities requiring holistic treatment 2.
- The first use of the term MASLD in hepatology research can be found in studies published in 2023 and later, indicating a recent evolution in the terminology used to describe steatotic liver disease associated with metabolic syndrome 3, 4.
Evolution of Terminology
- The terminological evolution from "nonalcoholic fatty liver disease" (NAFLD) to "metabolic dysfunction-associated fatty liver disease" (MAFLD) and finally "metabolic dysfunction-associated steatotic liver disease" (MASLD) has been paralleled by increased knowledge of mechanisms linking local and systemic pathogenic pathways 5.
- The term MASLD is now used to describe conditions involving fat accumulation in the liver, including metabolic dysfunction-associated SLD (MASLD), alcohol-associated liver disease (ALD), and metabolic and ALD (Met-ALD) 6.
Research and Publications
- Studies published in 2023 and later have used the term MASLD to describe the condition, indicating a growing body of research on the topic 2, 5, 3, 6, 4.
- These studies have explored the pathophysiology, association with atherosclerosis and cardiovascular disease, and treatments for MASLD, highlighting the need for a holistic, multidisciplinary approach to address the global health burden of the condition 2, 5, 3.