Overview

The new name for Non-alcoholic steatohepatitis (NASH) has been renamed to Metabolic Dysfunction-Associated Steatohepatitis (MASH). This change was made to better reflect the metabolic nature of the disease and to avoid confusion with alcoholic liver disease. 

Nonalcoholic fatty liver disease (NAFLD) has also been replaced by metabolic dysfunction-associated steatotic liver disease (MASLD). 

The liver is an important organ that plays a crucial role in maintaining overall health. It performs several essential functions, including detoxification, metabolism, and nutrient storage.  

However, liver disease is a growing health concern that affects millions of people worldwide. One of the most common types of liver disease is fatty liver disease, which occurs when excessive fat accumulates in liver cells. 

MASLD – Metabolic Dysfunction-Associated Steatotic Liver Disease

MASLD, formerly NAFLD, is the most common chronic liver disease, affecting about 30% of the global population. 

This condition can progress to a more severe form, which involves liver inflammation and potential scarring, leading to cirrhosis and perhaps a liver transplant. 

Over the years, fatty liver disease has been defined and classified by various terms, leading to confusion among health care providers, researchers, and patients.  

To address this issue, multinational liver associations and patient advocacy groups convened a group to review naming and definition options for the stages of fatty liver disease.  

Introduction of Delphi Consensus Nomenclature

The new naming and classification system, called the Delphi Consensus Nomenclature, was introduced by the director of VCU’s Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Arun Sanyal, M.D., at an international conference in Vienna in August 2023. The new system emphasizes the metabolic underpinnings of the liver condition, aligning it more closely with its root causes, such as obesity or diabetes. 

The Delphi Consensus Nomenclature includes several changes to the naming and classification of fatty liver disease. 

The overarching term for the various causes of steatosis is now called steatotic liver disease (SLD).  

The term steatohepatitis, which is an important pathophysiological concept, has been retained.  

Nonalcoholic fatty liver disease (NAFLD) has been renamed metabolic dysfunction-associated steatotic liver disease (MASLD), which includes patients who have hepatic steatosis and have at least one of five cardiometabolic risk factors.  

What is Cardiometabolic?

refers to the interconnectedness between the heart and vascular system (cardiovascular) and the body’s ability to process and use energy (metabolic). Conditions affecting one system can often impact the other, increasing the risk of various health problems. 

5 Key Cardiometabolic Risk Factors: 

• Excess body weight and central obesity: Carrying excess weight, especially around the waist, increases strain on the heart and can contribute to insulin resistance, a precursor to diabetes. 
• Unhealthy diet: Diets high in saturated and trans fats, added sugars, and refined carbohydrates can contribute to high blood pressure, unhealthy cholesterol levels, and insulin resistance. 
• Physical inactivity: Regular physical activity helps manage weight, improve blood sugar control, and boost cardiovascular health. Lack of exercise increases the risk of these disorders. 
• High blood pressure: Elevated blood pressure puts additional stress on the heart, arteries, and other organs, increasing the risk of heart disease, stroke, and kidney problems. 
• Dyslipidemia: Abnormal levels of cholesterol and triglycerides in the blood can contribute to plaque buildup in arteries, leading to heart disease and stroke. 

 A new category, called MetALD, now describes those with MASLD who consume amounts of alcohol per week than 140 g/week for women and 210 g/week for men. Metabolic dysfunction-associated steatohepatitis (MASH) replaces NASH. 

https://liverinstitute.medschool.vcu.edu/news/understanding-new-liver-disease-names/

Purpose Of New Nomenclature in Liver Disease 

The new nomenclature aims to improve communication among health care providers, researchers, and patients, leading to tailored treatment plans and patient empowerment. To manage steatosis liver disease, physicians can implement various treatment strategies, including encouraging patients with MASLD to adopt a healthy lifestyle, including regular exercise, a balanced diet, and weight management.  

They can also advise alcohol abstinence or moderation, depending on the severity of liver damage, for patients with AALD. 

For MASLD patients who haven’t achieved sufficient improvement through lifestyle changes alone, physicians can consider prescribing medications. Regular monitoring of liver function and other factors can track treatment progress and ensure patient adherence.  

Physicians can also work with other healthcare professionals, such as dietitians, hepatologists, and addiction specialists, to provide comprehensive support for patients. 

Overall, the new Delphi Consensus Nomenclature for liver disease aims to improve the management of fatty liver disease by providing a more precise and patient-centered approach. With clearer communication, tailored treatment plans, and patient empowerment, health care providers, patients, and the public can work together towards fostering a healthy future for all. 

Frequently Asked Questions 

What is the new name for NASH liver disease? 

Non-alcoholic steatohepatitis (NASH) has been renamed metabolic dysfunction-associated steatohepatitis (MASH). This change was made to better reflect the metabolic nature of the disease and to avoid confusion with alcoholic liver disease. 

How does MASH cirrhosis differ from NASH cirrhosis? 

MASH cirrhosis and NASH cirrhosis are both caused by the accumulation of fat in the liver, but MASH is associated with metabolic dysfunction while NASH is not. MASH cirrhosis may progress more rapidly than NASH cirrhosis, and patients with MASH cirrhosis may have a worse prognosis. 

What does MASLD stand for in liver disease? 

MASLD stands for metabolic dysfunction-associated liver disease. It is a new term that encompasses both MASH and non-alcoholic fatty liver disease (NAFLD). 

What is the life expectancy for a patient diagnosed with NASH cirrhosis? 

The life expectancy for a patient diagnosed with NASH cirrhosis can vary depending on the severity of the disease and the patient’s overall health. In general, patients with cirrhosis have a higher risk of liver failure and liver cancer, and their life expectancy may be reduced. 

Why has the term NASH been replaced with a different acronym? 

The term NASH has been replaced with MASH to better reflect the metabolic nature of the disease and to avoid confusion with alcoholic liver disease. The new name is also more inclusive, as it encompasses both NASH and NAFLD. 

What are the main differences between MAFLD and the previous terms for fatty liver diseases? 

The main difference between MAFLD and the previous terms for fatty liver diseases is that MAFLD requires either metabolic dysfunction or obesity in addition to hepatic steatosis. This change was made to better reflect the underlying causes of the disease and to improve diagnostic accuracy. 

What are the implications of the Delphi consensus on liver disease nomenclature? 

The Delphi consensus on liver disease nomenclature has important implications for the diagnosis and management of patients with liver diseases. The use of a standardized nomenclature can improve communication between healthcare professionals and help to identify patients who require further investigation and treatment. 

What is the expected prognosis for patients diagnosed with NASH cirrhosis? 

The expected prognosis for patients diagnosed with NASH cirrhosis is poor, with a higher risk of liver-related mortality compared to patients with non-cirrhotic NASH. However, early diagnosis and treatment can improve outcomes and reduce the risk of liver-related complications. 

What is the new nomenclature for NASH liver disease? 

The new nomenclature for NASH liver disease is MASH (metabolic associated fatty liver disease) as recommended by a multi-society Delphi consensus statement. This new name is expected to improve the diagnosis and management of patients with fatty liver disease.