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Semin Liver Dis 2024; 44(01): 035-042
DOI: 10.1055/s-0044-1785196
Review Article

New Nomenclature for Nonalcoholic Fatty Liver Disease: Understanding Metabolic Dysfunction-Associated Steatotic Liver Disease, Metabolic Dysfunction- and Alcohol-Associated Liver Disease, and Their Implications in Clinical Practice

Clémence M. Canivet
1   Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France
2   HIFIH Laboratory UPRES EA3859, Angers University, Angers, France
,
Jérôme Boursier
1   Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France
2   HIFIH Laboratory UPRES EA3859, Angers University, Angers, France
,
Rohit Loomba
3   Division of Gastroenterology and Hepatology, Department of Medicine, MASLD Research Center, University of California at San Diego, La Jolla, California
› Author Affiliations Funding R.L. received funding support from National Center for Advancing Translational Sciences (5UL1TR001442), National Institute of Diabetes and Digestive and Kidney Diseases (U01DK061734, U01DK130190, R01DK106419, R01DK121378, R01DK124318, P30DK120515), National Heart, Lung, and Blood Institute (P01HL147835), and National Institute on Alcohol Abuse and Alcoholism (U01AA029019).
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Abstract

In June 2023, under the patronage of the American Association for Study of Liver Disease, the European Association for Study of the Liver, and the Asociación Latinoamericana para el Estudio del Hígado with the involvement of 236 participants from around the world, a new nomenclature and definition for nonalcoholic fatty liver disease (NAFLD) has been proposed. Metabolic dysfunction-associated steatotic liver disease (MASLD) was defined as presence of hepatic steatosis and at least one of the cardiometabolic risk factors with alcohol intake less than 140 g/wk for women and 210 g/wk for men and no other causes of steatosis. A new entity called combined metabolic dysfunction- and alcohol-associated liver disease (MetALD) was created outside of pure MASLD for patients with metabolic dysfunction and alcohol intake greater than that allowed for MASLD (i.e., 140–350 g/wk for women and 210–420 g/wk for men). Recent studies have confirmed a 95% overlap between NAFLD and the new MASLD diagnostic criteria. Natural history, biomarkers, and thresholds of alcohol intake in MetALD group remains to be studied and validated.

Keywords

NAFLD - MASLD - MetALD - nomenclature - cardiometabolic


Publication History

Article published online:
26 March 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55 (07) 434-438
    PubMedGoogle Scholar
  • 2 Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis 1986; 8: 283-298
    PubMedGoogle Scholar
  • 3 Eslam M, Sanyal AJ, George J. International Consensus Panel. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology 2020; 158 (07) 1999-2014.e1
    CrossrefPubMedGoogle Scholar
  • 4 Eslam M, Newsome PN, Sarin SK. et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol 2020; 73 (01) 202-209
    CrossrefPubMedGoogle Scholar
  • 5 Younossi ZM, Rinella ME, Sanyal AJ. et al. From NAFLD to MAFLD: implications of a premature change in terminology. Hepatology 2021; 73 (03) 1194-1198
    CrossrefPubMedGoogle Scholar
  • 6 Rinella ME, Lazarus JV, Ratziu V. et al; NAFLD Nomenclature consensus group. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023; 79 (06) 1542-1556
    CrossrefPubMedGoogle Scholar
  • 7 Schneider KM, Schneider CV. A new era for steatotic liver disease: evaluating the novel nomenclature in the UK biobank. J Hepatol 2024; 80 (02) e58-e60
    CrossrefPubMedGoogle Scholar
  • 8 Amacher DE, Chalasani N. Drug-induced hepatic steatosis. Semin Liver Dis 2014; 34 (02) 205-214
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Ratziu V, Boursier J, De Ledinghen V, Anty R, Costentin C, Bureau C. Confirmatory biomarker diagnostic studies are not needed when transitioning from NAFLD to MASLD. J Hepatol 2024; 80 (02) e51-e52
    CrossrefPubMedGoogle Scholar
  • 10 Ciardullo S, Carbone M, Invernizzi P, Perseghin G. Exploring the landscape of steatotic liver disease in the general US population. Liver Int 2023; 43 (11) 2425-2433
    CrossrefPubMedGoogle Scholar
  • 11 Perazzo H, Pacheco AG, Griep RH, Gracindo R, Goulart AC, Mendes Da Fonseca MDJ. Changing from NAFLD through MAFLD to MASLD: similar prevalence and risk factors in a large Brazilian cohort. J Hepatol 2024; 80 (02) e72-e74
    CrossrefPubMedGoogle Scholar
  • 12 Arora U, Biswas S, Aggarwal S, Duseja A. , Shalimar MASLD screening and diagnostic algorithms are interchangeable from existing NAFLD literature. J Hepatol 2024; 80 (02) e89-e91
    CrossrefPubMedGoogle Scholar
  • 13 Loomba R, Wong VWS. Implications of the new nomenclature of steatotic liver disease and definition of metabolic dysfunction-associated steatotic liver disease. Aliment Pharmacol Ther 2024; 59 (02) 150-156
    CrossrefPubMedGoogle Scholar
  • 14 Ng CH, Chan KE, Ou KQ. et al. IDDF2022-ABS-0132 MAFLD and NAFLD in lean individuals. A prospective analysis of 12,505 lean individuals. Gut 2022; 71 (Suppl. 02) A50-A50
    PubMedGoogle Scholar
  • 15 Duseja A, De A, Wong V. Special population: lean nonalcoholic fatty liver disease. Clin Liver Dis 2023; 27 (02) 451-469
    CrossrefPubMedGoogle Scholar
  • 16 Long MT, Noureddin M, Lim JK. AGA clinical practice update: diagnosis and management of nonalcoholic fatty liver disease in lean individuals: expert review. Gastroenterology 2022; 163 (03) 764-774.e1
    CrossrefPubMedGoogle Scholar
  • 17 De A, Bhagat N, Mehta M, Taneja S, Duseja A. Metabolic dysfunction-associated steatotic liver disease (MASLD) definition is better than MAFLD criteria for lean patients with non-alcoholic fatty liver disease (NAFLD). J Hepatol 2024; 80 (02) e61-e62
    CrossrefPubMedGoogle Scholar
  • 18 En Li Cho E, Ang CZ, Quek J. et al. Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Gut 2023; 72 (11) 2138-2148
    CrossrefPubMedGoogle Scholar
  • 19 Huang DQ, Wilson LA, Behling C. et al; NASH Clinical Research Network. Fibrosis progression rate in biopsy-proven nonalcoholic fatty liver disease among people with diabetes versus people without diabetes: a multicenter study. Gastroenterology 2023; 165 (02) 463-472.e5
    CrossrefPubMedGoogle Scholar
  • 20 He L, Zheng W, Qiu K, Kong W, Zeng T. Changing from NAFLD to MASLD: the new definition can more accurately identify individuals at higher risk for diabetes. J Hepatol 2024; 80 (02) e85-e87
    CrossrefPubMedGoogle Scholar
  • 21 Lee HH, Lee HA, Kim EJ. et al. Metabolic dysfunction-associated steatotic liver disease and risk of cardiovascular disease. Gut 2024; 73 (03) 533-540
    PubMedGoogle Scholar
  • 22 Zhao Q, Deng Y. Comparison of mortality outcomes in individuals with MASLD and/or MAFLD. J Hepatol 2024; 80 (02) e62-e64
    CrossrefPubMedGoogle Scholar
  • 23 Li M, Xie W. Are there all-cause mortality differences between metabolic dysfunction-associated steatotic liver disease subtypes?. J Hepatol 2024; 80 (02) e53-e54
    CrossrefPubMedGoogle Scholar
  • 24 Ajmera V, Loomba R. Advances in the genetics of nonalcoholic fatty liver disease. Curr Opin Gastroenterol 2023; 39 (03) 150-155
    CrossrefPubMedGoogle Scholar
  • 25 Kokkorakis M, Boutari C, Katsiki N, Mantzoros CS. From non-alcoholic fatty liver disease (NAFLD) to steatotic liver disease (SLD): an ongoing journey towards refining the terminology for this prevalent metabolic condition and unmet clinical need. Metabolism 2023; 147: 155664
    CrossrefPubMedGoogle Scholar
  • 26 Glyn-Owen K, Böhning D, Parkes J, Roderick P, Buchanan R. The combined effect of alcohol and body mass index on risk of chronic liver disease: a systematic review and meta-analysis of cohort studies. Liver Int 2021; 41 (06) 1216-1226
    CrossrefPubMedGoogle Scholar
  • 27 Loomba R, Yang HI, Su J. et al. Synergism between obesity and alcohol in increasing the risk of hepatocellular carcinoma: a prospective cohort study. Am J Epidemiol 2013; 177 (04) 333-342
    CrossrefPubMedGoogle Scholar
  • 28 Loomba R, Yang HI, Su J, Brenner D, Iloeje U, Chen CJ. Obesity and alcohol synergize to increase the risk of incident hepatocellular carcinoma in men. Clin Gastroenterol Hepatol 2010; 8 (10) 891-898 , 898.e1–898.e2
    CrossrefPubMedGoogle Scholar
  • 29 Loomba R, Bettencourt R, Barrett-Connor E. Synergistic association between alcohol intake and body mass index with serum alanine and aspartate aminotransferase levels in older adults: the Rancho Bernardo Study. Aliment Pharmacol Ther 2009; 30 (11-12): 1137-1149
    CrossrefPubMedGoogle Scholar
  • 30 Åberg F, Luukkonen PK, But A. et al. Development and validation of a model to predict incident chronic liver disease in the general population: the CLivD score. J Hepatol 2022; 77 (02) 302-311
    CrossrefPubMedGoogle Scholar
  • 31 Jarvis H, O'Keefe H, Craig D, Stow D, Hanratty B, Anstee QM. Does moderate alcohol consumption accelerate the progression of liver disease in NAFLD? A systematic review and narrative synthesis. BMJ Open 2022; 12 (01) e049767
    CrossrefPubMedGoogle Scholar
  • 32 Blomdahl J, Nasr P, Ekstedt M, Kechagias S. Moderate alcohol consumption is associated with significant fibrosis progression in NAFLD. Hepatol Commun 2023; 7 (01) e0003
    CrossrefPubMedGoogle Scholar
  • 33 Díaz LA, Arab JP, Louvet A, Bataller R, Arrese M. The intersection between alcohol-related liver disease and nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2023; 20 (12) 764-783
    CrossrefPubMedGoogle Scholar
  • 34 Israelsen M, Torp N, Johansen S. et al; GALAXY consortium. Validation of the new nomenclature of steatotic liver disease in patients with a history of excessive alcohol intake: an analysis of data from a prospective cohort study. Lancet Gastroenterol Hepatol 2024; 9 (03) 218-228
    CrossrefPubMedGoogle Scholar
  • 35 Chen L, Tao X, Zeng M, Mi Y, Xu L. Clinical and histological features under different nomenclatures of fatty liver disease: NAFLD, MAFLD, MASLD and MetALD. J Hepatol 2024; 80 (02) e64-e66
    CrossrefPubMedGoogle Scholar
  • 36 Song SJ, Lai JC, Wong GL, Wong VW, Yip TC. Can we use old NAFLD data under the new MASLD definition?. J Hepatol 2024; 80 (02) e54-e56
    CrossrefPubMedGoogle Scholar
  • 37 Hagström H, Vessby J, Ekstedt M, Shang Y. 99% of patients with NAFLD meet MASLD criteria and natural history is therefore identical. J Hepatol 2024; 80 (02) e76-e77
    CrossrefPubMedGoogle Scholar
  • 38 Yang A, Zhu X, Zhang L, Ding Y. Transitioning from NAFLD to MAFLD and MASLD: consistent prevalence and risk factors in a Chinese cohort. J Hepatol 2023; S0168-8278 (23)05161-9
    PubMedGoogle Scholar
  • 39 Iruzubieta P, Santos-Laso A, Arias-Loste MT, Calleja JL, Crespo J. Evaluation of metabolic dysfunction-associated steatotic liver disease (MASLD) terminology in different clinical settings. J Hepatol 2024; 80 (03) e121-e123
    CrossrefPubMedGoogle Scholar