Great read from Clinical Care Solutions on the Policy & Medicine (a CEA publication) aka PolicyMed—
“Solving the Fatty Liver Mistry: What’s in a Name? Understanding the Terminology Shift for Fatty Liver Disease”
Clinical Care Solutions
By Thomas Sullivan Last updated Feb 7, 2025
In the medical field, terminology not only guides clinical understanding and patient communication but also impacts research, policy, and public perception. A recent shift in the nomenclature of fatty liver disease, explained by Dr. Neeraj Mistry in Solving the Fatty Liver Mistry, highlights significant changes aimed at improving the clarity and reducing the stigma associated with this common condition.
The Old and the New: From NAFLD and NASH to MASLD and MASH
Traditionally, the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) were used to describe the progression of liver disease in individuals without significant alcohol consumption. However, these terms were problematic for several reasons. Firstly, they define the disease by the absence of alcohol rather than its actual characteristics. Secondly, the term “fatty” carries pejorative connotations, suggesting laziness and poor self-care, which can stigmatize patients.
To address these issues, the terminology has evolved to metabolic dysfunction associated steatotic liver disease (MASLD) for the broader condition and metabolic dysfunction associated steatohepatitis (MASH) for its more advanced form. This new naming convention aims to more accurately reflect the metabolic underpinnings of the disease and eliminate the stigma associated with the old terminology.
Why Change the Name?
Dr. Mistry outlines several key motivations for the terminology change:
- Reducing Stigma: The previous terms could contribute to patient stigmatization, which can affect their willingness to seek treatment or participate in clinical trials.
- Reflecting True Etiology: The new terms better describe the disease’s association with metabolic syndrome, obesity, and type 2 diabetes, rather than merely indicating the absence of alcohol.
- Enhancing Research and Policy: Clearer terminology can help align clinical and research efforts and improve the allocation of resources for better disease management and therapy development.
The Broader Implications of New Terminology
The reclassification into MASLD also considers the overlapping influences of lifestyle factors, including diet and alcohol consumption, acknowledging that many patients do not fit neatly into categories solely defined by their alcohol intake. This holistic approach facilitates a more accurate diagnosis and management strategy tailored to the complex nature of the disease.