Alternative Names for Fatty Liver
The term "fatty liver" is now referred to as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), which replaced the older term Nonalcoholic Fatty Liver Disease (NAFLD) in 2023. 1
Historical Evolution of Terminology
The nomenclature for fatty liver disease has undergone significant evolution:
NAFLD (Nonalcoholic Fatty Liver Disease): The traditional term coined in 1986, defined by hepatic steatosis in the absence of significant alcohol consumption (>21 standard drinks per week in men, >14 in women over 2 years). 2
MAFLD (Metabolic Dysfunction-Associated Fatty Liver Disease): Introduced in 2020 by Asian-Pacific experts as an intermediate terminology to better reflect the metabolic pathophysiology. 3, 4
MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease): The current preferred term established in 2023 by a consensus panel under the auspices of EASL, EASD, and EASO, now officially adopted by major liver societies. 1, 5
Rationale for Name Change
The shift from NAFLD to MASLD addresses several critical issues:
Removes stigmatizing language: The terms "nonalcoholic" and "fatty" were deemed misleading and inappropriate, potentially causing patient stigma. 2, 5
Provides positive diagnostic criteria: MASLD requires hepatic steatosis plus at least one of five cardiometabolic risk factors (elevated BMI/waist circumference, impaired glucose metabolism, hypertension, elevated triglycerides, or low HDL cholesterol), rather than diagnosis by exclusion. 1, 5
Better reflects pathophysiology: The new terminology emphasizes the underlying metabolic dysfunction and insulin resistance driving the disease process. 2
Related Terminology You Should Know
Hepatic steatosis: The histological term describing triglyceride accumulation within hepatocytes (≥5% of liver cells). 6, 7
MASH (Metabolic Dysfunction-Associated Steatohepatitis): Replaces NASH, defined as steatosis with inflammation and hepatocyte ballooning, with or without fibrosis. 1
MetALD (Metabolic and Alcohol-Associated Liver Disease): A new category for patients with MASLD criteria who consume 140-350 g/week alcohol (women) or 210-420 g/week (men)—amounts between MASLD limits and alcoholic liver disease thresholds. 2, 5, 8
Alcoholic fatty liver/alcoholic steatosis: When fatty liver results from excessive alcohol consumption. 9
Clinical Implications of the New Nomenclature
Use MASLD in all clinical documentation and patient communication moving forward, as this is the internationally accepted standard terminology endorsed by the American Diabetes Association, European liver societies, and Asian hepatology organizations. 2, 1, 10
The prevalence estimates remain similar across terminologies—affecting approximately 25-30% of the general population globally, though MAFLD criteria identify slightly more patients (higher prevalence) than NAFLD criteria due to the positive diagnostic approach. 1, 11