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Page 8 of 11 Sanal et al. Metab Target Organ Damage 2024;4:45 https://dx.doi.org/10.20517/mtod.2024.54

Table 1. NAFLD vs. MASLD
Feature NAFLD MAFLD MASLD
Definition Fatty liver, not due to alcohol Fatty liver with metabolic Fatty liver with metabolic dysfunction
dysfunction
Diagnostic Fat in liver, low alcohol intake Fat in liver, with metabolic Fat in liver, low alcohol intake, metabolic abnormality
criteria abnormality and no other cause for liver disease (e.g., viral
hepatitis or autoimmune disease)
Focus Presence of fat but not due to Metabolic link Metabolic link with exclusion of other diseases
alcohol
Current status Well-established term Replacement Latest proposed controversial replacement
Advantage Simple, well-established, classic; Focus on fatty liver associated with Inventors claim the term is more politically correct
Self-explanatory-easy to metabolic syndrome
understand by the public
Disadvantages An umbrella term (less focus on Metabolic dysfunction-associated Does not define a disease based solely on positive
the cause/association with fatty liver disease- does not specify criteria;
metabolic syndrome) which metabolic dysfunction; Diagnostic criteria require positive attributes (fat and
Dysfunction is clarified in the metabolic dysfunction) and negative attributes
detailed classification (particular levels of alcohol consumption, exclusion
of other diseases, etc.);
Creates an extra term (metALD precisely because it
does not define the disease in positive terms);
Changes in nomenclature cause confusion among the
scientific community and the public;
Frequent changes in nomenclature cause confusion
among the scientific community and the public;
The new nomenclature has no additional scientific
merit to earlier terms;
Technically, steatosis is a histopathological diagnosis
that requires a biopsy;
The term was proposed through a less transparent
process and did not involve proportionate
representation of different geographic locations
across the world
Metabolic Diagnosis is made without the Patients are placed in homogenous MASLD necessitates that a patient has at least one of
criteria need for a standardized groups represented by those with: five prescribed metabolic risk factors
assessment of metabolic (1) Obesity: BMI greater than or
2
dysfunction equal to 25 kg/m (or greater than
2
or equal to 23 kg/m in Asian
populations);
(2) Type 2 diabetes: A formal
diagnosis of diabetes;
(3) Normal weight by ethnic-
specific criteria with two or more of
7 defined metabolic risk factors
Alcohol Consumption of alcohol above a MAFLD diagnosis is made only on A MASLD diagnosis allows for a certain arbitrary
consumption certain arbitrary level is an the basis of metabolic dysfunction level of alcohol consumption
exclusion criterion
NAFLD: Non-alcoholic fatty liver disease; MAFLD: metabolic associated fatty liver disease; MASLD: metabolic dysfunction-associated steatotic
liver disease; BMI: body mass index.

Moreover, renaming diseases solely to make them more accessible can inadvertently perpetuate stigma and
misconceptions. For example, renaming “pancreatic cancer” to “pancreatic karkinos” (to counter stigma
and fear associated with cancer) or telling patients they have a “hematoma” (instead of bruise), “epistaxis”
(instead of nose bleed), “dyspnoea” (instead of breathlessness), or “urticaria” (instead of hives), may not
only confuse patients but also inadvertently reinforce negative associations and fears surrounding the
disease. Instead, efforts should be directed toward education and awareness campaigns to destigmatize
diseases and promote early detection and treatment.

In navigating the balance between accuracy and accessibility in disease naming, collaboration among
healthcare professionals, researchers, patients, and advocacy groups is crucial. By engaging in open dialogue
and considering diverse perspectives, stakeholders can develop terminology that is both accurate and