Answer:
Fatty Liver and the New Terminology (MASLD/MASH)
1. Updated Terminology (2023–Present) The medical community has recently updated the terminology for fatty liver diseases to better reflect their underlying causes and reduce stigma. Here’s what’s new:
- Nonalcoholic Fatty Liver Disease (NAFLD) is now called Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD).
- Nonalcoholic Steatohepatitis (NASH) is now called Metabolic Dysfunction–Associated Steatohepatitis (MASH).
These changes emphasize that these conditions are strongly linked to metabolic dysfunction (e.g., obesity, diabetes, high cholesterol) rather than just alcohol use. The term "nonalcoholic" has been replaced to avoid stigmatizing patients who may not drink alcohol excessively (1).
2. Key Definitions
- MASLD: Presence of liver fat (steatosis) + at least one of the following:
- Overweight/obesity
- Type 2 diabetes or prediabetes
- High blood pressure, or elevated liver enzymes (ALT/AST) (1).
- MASH: MASLD + inflammation and liver cell damage (similar to the old "NASH" definition) (2).
3. Why the Change? The old terms (NAFLD/NASH) were misleading because:
- They assumed no alcohol use, which isn’t always true (some patients may drink lightly).
- They didn’t highlight the link to metabolic conditions like diabetes or heart disease.
- The new terms (MASLD/MASH) better reflect the disease’s true causes and encourage earlier intervention (1).
4. Symptoms and Screening
- Most patients are asymptomatic or have mild symptoms like fatigue, right upper quadrant pain, or elevated liver enzymes.
- Screening is recommended for people with metabolic risk factors (e.g., obesity, diabetes, high cholesterol). Tests may include blood work (ALT/AST), imaging (ultrasound), or fibrosis markers (FIB-4, ELF) (3).
5. Management and When to Seek Help
- Lifestyle changes (weight loss, healthy diet, exercise) are first-line treatments.
- If fibrosis is suspected (via FIB-4, liver stiffness), a referral to a gastroenterologist is advised for monitoring and potential medications (if approved in the future) (4).
References:
- PMC - Updated naming and diagnosis criteria for fatty liver disease (2023)
- EASL 2023 guidelines on MASLD/MASH
- Clinical practice guidelines for metabolic syndrome
- AASLD 2024 recommendations
Note: If you suspect you have fatty liver, consult your doctor, especially if you have metabolic risk factors. Early detection and lifestyle changes are key to preventing progression.