New nomenclature for liver disease (NASH and NAFLD vs MASH and MASLD)

New nomenclature for liver disease (NASH and NAFLD vs MASH and MASLD)

The liver diseases of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have changed names by a modified Delphi process led by three large pan-national liver associations composed of 236 panellists from 56 countries.

NAFLD is now called metabolic dysfunction-associated steatotic liver disease (MASLD), and NASH has been replaced by the term metabolic dysfunction-associated steatohepatitis (MASH).

Towards a non-stigmatising terminology to increase disease awareness

These changes have been motivated, on the one hand, by the confounding nature of the term “nonalcoholic”, which does not reflect the aetiology of the disease, and on the other, by the stigmatising nature of the words “nonalcoholic” and “fatty”. Nevertheless, steatohepatitis was considered an essential pathophysiological concept that should be retained.

Besides the change in the terminology, there was a consensus to change the definition of NAFLD to include at least 1 of 5 cardiometabolic risk factors.

Moreover, there are individuals with risk factors for MASLD, such as type 2 diabetes, who consume more alcohol than the relatively strict thresholds used to define the nonalcoholic nature of the disease, which is not adequately recognised by existing nomenclature and are excluded from trials and consideration for treatments.

A new category, called metabolic dysfunction and alcohol-associated/related liver disease (metALD), has been defined for those with MASLD who consume amounts of alcohol greater than 140-350 g/week for women and 210-420 g/week for men. Although MASLD is not associated with alcohol intake, it was considered relevant to comment on situations where there was overlap, represented by this new category. Within the group of patients with MetALD, there may be individuals where MASLD is the perceived dominant driver and others where alcoholic liver disease (ALD) is the perceived dominant driver.

Embracing unified global approaches to nomenclature that do not impact stigma and marginalisation helps to increase disease awareness, drive policy change, identify those at risk, and facilitate diagnosis and access to care without perpetuating health inequalities. This process provides a robust platform for a good start.


Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology.2023;78(6):1966-1986

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New nomenclature for liver disease (NASH and NAFLD vs MASH and MASLD)
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