NAFLD to MASLD: What’s In A Name Change?
What you need to know about non-alcoholic fatty liver disease’s new name, metabolic dysfunction-associated steatotic liver disease.
Origins of “Nonalcoholic Fatty Liver Disease”
In 1980, Jurgen Ludwig and his team at the Mayo Clinic noticed a number of patients that showed fat buildup in the liver– similar to patients with “alcoholic liver disease”, but without the excessive drinking. The researchers coined the name “nonalcoholic fatty liver disease” (NAFLD) to distinguish this disease from its alcoholic counterpart. They also introduced “nonalcoholic steatohepatitis” (NASH) to describe the progression of NAFLD as the liver swells. This swelling leads to liver fibrosis, scarring in the liver, which reduces the function of liver cells and can result in liver cancer or death.
Worldwide Takeover
In the decades since, “fatty liver” has become one of the leading causes of liver disease– over 1 billion people are affected by the disease worldwide. Children are growing as a demographic among those affected. Patients and their families face intense financial stress to get treatment. $100 billion dollars each year are estimated to be directly associated with the disease in the United States alone. As knowledge of NAFLD has grown, many experts have felt that NAFLD is no longer an effective name, resulting in a worldwide discussion on how to rename the disease.
A Slight Change?
In 2020, a consensus panel composed of experts on “fatty liver” from around the world proposed a new name for the disease: “metabolic associated fatty liver disease” (MAFLD). The panel stated that the term “alcoholic” would result in stigma associated with drinking and place blame on the patient. Diseases associated with certain behaviors, such as drinking, drug use, and eating habits, are treated less seriously. These behaviors are seen as a choice on the part of the patient, making any health problems that arise their burden to face alone. A disease’s name plays a big role when it comes to finding resources to research or treat the disease: if industry officials or policymakers view a disease with stigma, millions of lives could be at risk.
The group also stated that the “non” in “nonalcoholic” was trivializing language, and only served to separate the disease from “alcoholic fatty liver disease”. They argued that the disease should not be defined by absence of alcohol consumption, but by the presence of metabolic dysfunction in patients.
The Consensus: MASLD
In 2023, a new consensus panel of over 200 experts, supported by multiple liver associations, reached a conclusion on the new name of the disease: metabolic dysfunction-associated steatotic liver disease (MASLD). Like the last consensus, the panel took issue with the potentially stigmatizing language of NAFLD. 61% of respondents felt the term “nonalcoholic" was stigmatizing. The new name also addressed concerns about the use of “fatty” in MAFLD, which was seen as stigmatizing by 66% of respondents.
The Importance of Reducing Stigma
The language used in MASLD’s old names had a real impact on the lives and self-perception of patients. Jonathan Stine, director of the Fatty Liver Program at Penn State Health, reported to STAT News that he has had “patients hear the word ‘fatty’ before” and “become very emotional,” to the point of crying.
How diseases are named has great influence on public perception and stigmatization, and can add more burden on the people diagnosed with the disease. This has major consequences when it comes to raising awareness and funding research on life-saving treatments. A growing number of people are being diagnosed with MASLD, forcing them into navigating the world of finding effective, affordable treatment. Now, more than ever, it is crucial that we choose our language to speak about the disease with care and consideration for the people whose lives are affected by it.
Sources
Cueto, I. (2023, December 28). Renamed, common liver diseases might get fairer shake at treatment, researchers hope. STAT. https://www.statnews.com/2023/12/28/liver-disease-masld-nafld-mash-nash-metald/
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Eslam, M., Sanyal, A. J., George, J., Sanyal, A., Neuschwander-Tetri, B., Tiribelli, C., Kleiner, D. E., Brunt, E., Bugianesi, E., Yki-Järvinen, H., Grønbæk, H., Cortez-Pinto, H., George, J., Fan, J., Valenti, L., Abdelmalek, M., Romero-Gomez, M., Rinella, M., Arrese, M., & Eslam, M. (2020). MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology, 158(7), 1999-2014.e1. https://doi.org/10.1053/j.gastro.2019.11.312
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