Renaming ‘Fatty Liver or NAFLD to ‘MAFLD’

Highlights:

Nonalcoholic Fatty Liver disease (NAFLD) is renamed Metabolic dysfunction–Associated Steatotic Liver Disease (MASLD), and MASH to NASH, by global liver societies
The new nomenclature classifies SLD (Steatotic Liver Diseases) into four types: MASLD, MetALD, ALD, and cryptogenic SLD //
The new classification helps to avoid stigmatization among patients and improves diagnosis and treatment of liver diseases

Disease names play challenging and frequently unappreciated functions. They ought to be precise and elucidate conditions without stigmatizing the persons who suffer from them. Certain names become incorrect and need to be revised as a result of evolving social attitudes and an improved understanding of the disease.

Nonalcoholic liver disease is a metabolic disease. Fat builds up in the liver's cells, resulting in inflammation and scarring that may eventually lead to liver cancer or the need for a transplant ().

A worldwide panel of 236 doctors, patients, public health, and regulatory professionals reached a consensus that the phrase "nonalcoholic fatty liver disease" can be stigmatizing.

Hence the term "metabolic dysfunction-associated steatotic liver disease," or MASLD, has replaced "nonalcoholic fatty liver disease," reflecting the disease's underlying principles and altering the way that patients are referred to.

Fatty Liver Disease: A Growing Health Problem in India
Non alcoholic fatty liver disease (NAFLD) is the leading cause of liver dysfunction worldwide and is a rapidly growing health problem in India.

‘Did you know? Approximately 30% of people across the globe, suffer from fatty liver. It might be revolutionary to redefine NAFLD as MAFLD in order to eliminate the societal stigma associated with the illness. #fattyliver #nafldtomafld #nashtomash #liverhealth #medindia’

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The MAFLD Nomenclature

Nonalcoholic fatty liver disease will now be called metabolic dysfunction–associated steatotic liver disease, or MASLD, and Metabolic dysfunction–associated steatohepatitis, or MASH, will replace the term nonalcoholic steatohepatitis, or NASH ().

The new nomenclature includes the umbrella term steatotic liver disease, or SLD, which includes MASLD and MetALD (Metabolic Alcohol Associated Liver Disease), a term describing people with MASLD who consume more than 140 grams of alcohol per week for women and 210 grams per week for men ().

MASLD patients must have cardiometabolic risk factors such as type 2 diabetes, hypertension, obesity, and high cholesterol. Individuals without metabolic parameters and no known cause will be classified under cryptogenic SLD.
So, the umbrella term, SLD-Steatotic Liver Disease, covers:

MASLD- Metabolic dysfunction–Associated Steatotic Liver Disease - fatty liver with cardiometabolic risk factors that progresses to MASH (Metabolic dysfunction–Associated Steato Hepatitis)
MetALD- Metabolic Alcohol Associated Liver Disease. MAFLD with alcohol intake
ALD- Alcohol Associated Liver Disease
Cryptogenic SLD- Fatty liver without cardiometabolic risk factors and no known cause

The effort was spearheaded by three international liver societies: La Asociación Latinoamericana para el Estudio del Hígado, the American Association for the Study of Liver Diseases, and the European Association for the Study of the Liver, as well as the co-chairs of the NAFLD Nomenclature Initiative.

Quiz on Liver
How many of us know that the liver is a vital organ the size of an American Football? To understand more about the liver and its functions spend a few minutes taking part in this ...

Why do we Need to Rename NAFLD to MAFLD?

The modification indicates a change in the way patients and doctors see a condition that impacts up to 30% of adults globally.

Preference on Inclusion Criteria:

NAFLD remains a diagnosis of exclusion, defined by the absence of known causes of liver disease (such as, alcohol, hence “non-alcoholic”) and steatosis. A shift towards inclusionary diagnostic criteria - ie, the presence of metabolic dysfunction, rather than the lack of other conditions - better reflects our knowledge of the underlying metabolic dysfunction that typically drives MAFLD.

Providing a definition for the MAFLD patient group facilitates better patient subtyping and opens the door to more effective clinical trials and individualized medication.

No More ‘Fatty’ and ‘Alcohol’ Definitions- Avoids Social Stigma:

By not mentioning alcohol, MAFLD avoids stigmatizing patients and prevents the diagnosis of alcoholic liver disease from competing with MAFLD.

Preliminary survey results showed that a greater percentage of participants (54%) saw "nonalcoholic" as troublesome than stigmatizing terms like "fatty." About sixty-one percent of respondents thought the labels "fatty" and "nonalcoholic" were stigmatizing.

Other factors:

Patients with moderate alcohol use and metabolic liver disease are now included in the MetALD category, which bridges the gap between MASLD and alcohol-related liver disease.

There may be an overlap in the diagnosis of NAFLD and alcohol-related liver disease, and the definition solves the problem of how to categorize with alcohol consumption.

Alcoholic Liver Disease
Encyclopedia section of medindia gives general information about Alcoholic Liver Disease.

Potential Benefits of Renaming

Positive diagnostic criteria for MAFLD help to establish a precise diagnosis and enable doctors to effectively target patients who are at high risk of complications or other metabolic co-morbidities.

While the new terminology largely preserves the existing disease definitions, it allows for alcohol use beyond present limits for nonalcoholic forms of the condition.

With the new MetALD category, disease courses in this important population can be assessed and addressed. Until now, such patients would have been excluded from clinical trials for MASLD, which means that we may not understand how they respond to treatment. This can enhance clinical decision-making and research in pharmacotherapies.

There is a continuum within MetALD where the condition can be viewed as either MASLD or ALD predominate theoretically.

Liver Failure
Liver failure occurs when the liver loses its ability to perform its normal functions of regeneration or repair. It can be a gradual or a sudden process.

Way Forward with MAFLD

Utilizing MAFLD instead of NAFLD nomenclature has major benefits for patients, research, and clinicians. Widely accepted and devoid of stigma, the new nomenclature and diagnostic standards have the potential to raise awareness and facilitate patient identification.

Thus, we argue that the name "MAFLD" is a positive step toward enhancing clinical care, raising public awareness, and reducing the stigma attached to NAFLD diagnosis.

References:

Steatotic (Fatty) Liver Disease - (https://my.clevelandclinic.org/health/diseases/15831-fatty-liver-disease)
Changing from NAFLD to MASLD: The new definition can more accurately identify individuals at higher risk for diabetes - (https://www.journal-of-hepatology.eu/article/S0168-8278(23)05164-4/fulltext)
A multisociety Delphi consensus statement on new fatty liver disease nomenclature - (https://www.journal-of-hepatology.eu/article/S0168-8278(23)00418-X/fulltext)

Source-Medindia