What is the new medical term for steatotic liver disease?

New Terminology for Steatotic Liver Disease

The new medical term for steatotic liver disease is Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), which has officially replaced the previous term Non-Alcoholic Fatty Liver Disease (NAFLD). 1

Rationale for the Terminology Change

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) have officially replaced the term NAFLD with MASLD in their 2024 clinical guidelines. This change was made to:

• Better reflect the metabolic etiology of the disease
• Provide a positive diagnosis based on the presence of cardiometabolic risk factors
• Move away from a diagnosis of exclusion (non-alcoholic) to one of inclusion (metabolic-associated) 1

New Classification System

The new terminology includes a comprehensive classification system:

• MASL: Metabolic Associated Steatosis Liver (simple steatosis)
• MASH: Metabolic Associated Steatohepatitis (steatohepatitis)
• MetALD: Metabolic and Alcoholic Liver Disease (for cases where alcohol consumption is higher than allowed for MASLD but lower than that attributed to alcoholic liver disease) 1, 2

Diagnostic Criteria for MASLD

Diagnosis of MASLD requires:

1. Evidence of hepatic steatosis (by imaging, biopsy, or biomarkers)
2. Presence of at least one cardiometabolic risk factor:
   • Overweight/obesity
   • Type 2 diabetes or prediabetes
   • Dyslipidemia
   • Hypertension
3. Absence of harmful alcohol consumption (<20 g/day in women and <30 g/day in men) 1

Screening Recommendations

The American Diabetes Association recommends screening for MASLD in:

• Adults with type 2 diabetes or prediabetes, particularly those with obesity or cardiometabolic risk factors
• Patients with persistently elevated liver enzymes
• Screening should be performed using the fibrosis-4 (FIB-4) index, even in patients with normal liver enzymes 3

Diagnostic Algorithm

1. First step: Calculate FIB-4 index

   • Score <1.3: Low risk of advanced fibrosis
   • Score 1.3-2.67: Indeterminate risk
   • Score >2.67: High risk 1

2. Second step (for indeterminate FIB-4):

   • Perform elastography (VCTE) or enhanced liver fibrosis (ELF) test
   • VCTE <8.0 kPa: Low risk
   • VCTE ≥8.0 kPa: High risk 3, 1

3. Referral: Patients with high-risk scores should be referred to a gastroenterologist or hepatologist 3

Clinical Implications of the New Terminology

The change from NAFLD to MASLD emphasizes the importance of metabolic factors in disease pathogenesis and progression. This shift aligns with current understanding that:

• The condition affects approximately 20-30% of the general population
• Prevalence increases to 70% in obesity and 90% in diabetes mellitus
• Liver fibrosis is the major predictor of morbidity and liver-related mortality 1, 2

Management Considerations

• Patients with low fibrosis risk should be reevaluated every 1-3 years
• Those with indeterminate risk and VCTE <8.0 kPa should receive intensified management of comorbidities and be reevaluated within 1 year
• Patients with high fibrosis risk require specialist referral and multidisciplinary care 3, 1

The new terminology better reflects our understanding of this common condition and provides a framework for diagnosis and management that focuses on metabolic dysfunction as the primary driver of disease.