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Topic: The Evolving Nomenclature of the Metabolic Fatty Liver

Syndromes: NAFLD/NASH and MAFLD/MASLD

Guest Editor

Prof. Amedeo Lonardo
Azienda Ospedaliero-Universitaria di Modena (-2023), Modena, Italy.

Special Issue Introduction

Over the past several decades, the nomenclature concerning metabolic fatty
liver syndromes (MFLS), including nonalcoholic fatty liver disease/nonalcoholic
steatohepatitis (NAFLD/NASH) and metabolic dysfunction-associated fatty liver
disease/metabolic dysfunction-associated steatotic liver disease (MAFLD/MASLD),
has undergone multiple iterations, ranging from “fatty liver” to “fatty infiltration of
the liver”, “hepatic steatosis”, “diabetic hepatitis”, “alcohol-like liver disease in the
nonalcoholic”, “bright liver syndrome”, “metabolic fatty liver disorders”, and “metabolic
fatty liver disease”, among others.

Key milestones in this evolving terminology include the introduction of “NASH” by
Ludwig et al. in 1980, “NAFLD” by Schaffner and Thaler in 1986, “MAFLD” by Eslam
et al. in 2020, and the recent addition of “MASLD” by Rinella et al. in 2023.

Various factors, both medical and non-medical, have prompted these changes.
Medically, there has been growing emphasis on establishing positive diagnostic
criteria (based on metabolic dysfunction) rather than relying on negative definitions
centered on alcohol consumption . Non-medically, concerns have been raised
regarding the stigmatizing connotations of terms such as “nonalcoholic” and “fatty”,
whose interpretations and social implications can vary dramatically across cultures,
geographical areas, and populations, partly leading to confusion among hepatologists.