New Year, New Name: NAFLD becomes MASLD

Jennifer Middleton, MD, MPH
Posted on January 1, 2024

Halfway through 2023, more than 200 experts in liver disease formalized their decision to rename non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). We now know that NAFLD/MASLD can co-exist with other types of liver disease, including alcoholic liver disease, and many concerns have been raised over the last few decades that “[NAFLD] trivialized the disease and ... would sometimes make patients feel bad to hear ‘fatty’ or a tie to alcohol.” There was also hope that this new label would spur needed research into a condition with limited treatment options that is rapidly increasing in prevalence across the developed world.

Other diseases have seen their nomenclature shift, also, when we either learn more about diseases themselves or their namesakes:

Wegener’s granulomatosis, for example, was renamed granulomatosis with polyangiitis because its namesake had strong Nazi ties. Infectious diseases have been renamed as more information emerges, as was the case with ...HIV/AIDS, which was initially called gay-related immune deficiency. Other illnesses, named for peoples (Spanish flu) and places (Ebola) and whole subspecies (hello, swine flu), have made the World Health Organization ask for a bit more care in naming diseases. Prejudices have long seeped into the names of sicknesses.

About four years ago, COVID-19 was originally described in the lay press as the Wuhan virus or the China virus; countless people of Asian descent in the United States experienced racist comments or worse during the COVID-19 pandemic. Medicine has an obligation to name diseases as accurately and fairly as possible.

Removing stigma from liver diseases is important because their prevalence continues to increase; it’s estimated that 25% to 30% of adults in the United States have MASLD, which costs the U.S. health care system 100 billion U.S. dollars every year.  For such a highly prevalent and costly disease, evidence-based treatment options are limited; current management centers on “lifestyle interventions, glucagon-like peptide-1 agonists, and bariatric surgery.” More accurate names and diagnostic categories for steatotic liver disease (SLD) will hopefully help break the “fruitless cycle” of failed pharmacologic interventions to reverse the liver damage they can cause.

You can read more about the MASLD renaming process (which also includes renaming NASH to MASH). The American Association for the Study of Liver Diseases also reviews the MASLD naming process and includes a useful infographic. Furthermore, articles on NAFLD in AFP published prior to this nomenclature change can be found in the AFP By Topic on Hepatitis and Other Liver Diseases.