COMMENT:
The term non-alcoholic fatty liver disease (NAFLD) is currently employed to describe the histological spectrum of steatosis to steatohepatitis. Although this nomenclature is widely used, its ability to efficiently capture the disease’s aetiology and comprehensively identify affected patients has recently fallen under scrutiny.
This study aimed to ascertain the perspectives of NAFLD experts and patient advocates regarding the need for a change in disease nomenclature and/or definition. Importantly, panellists demonstrated significant NAFLD-related expertise and were geographically and demographically diverse.
Key learnings:
Consensus was defined as a supermajority (67%) vote. The terms ‘non-alcoholic’ and ‘fatty’ were thought to be stigmatising by 61% and 66% of respondents, respectively. Moreover, 89% of respondents preferred a nomenclature describing the disease’s underlying metabolic causes over current exclusionary terminology. The term ‘steatohepatitis’, however, was felt to be central to describing the disease’s pathophysiology. Metabolic dysfunction-associated steatotic liver disease (MASLD) was ultimately proposed as an alternative to NAFLD. There was further consensus to amend the pathology’s diagnostic criteria to include the presence of at least one of five cardiometabolic risk factors. Lastly, to establish the permissibility of greater alcohol consumption, respondents erected a new disease category outside pure MASLD and alcohol-related liver disease (ALD), termed metabolic ALD (MetALD). Both nomenclatures were viewed as non-stigmatising and supportive of effective patient identification.
