Page 48 - Read Online

Page 10 of 16 Iruzubieta et al. Metab Target Organ Damage. 2025;5:10 https://dx.doi.org/10.20517/mtod.2024.143

[71]
populations or those with limited access to medical resources .

To achieve a significant impact on equity in the management of MASLD, it is imperative to integrate this
nomenclature and its implications into public health policies. The lack of integration into global strategies
[72]
could limit the effectiveness of interventions aimed at preventing and treating these diseases . Raising
global awareness of MASLD and its health impact through educational campaigns and outreach efforts is
necessary, with a particular focus on addressing healthcare inequalities and prevention policies.

KEY FACTORS IN IMPLEMENTING MASLD
The transition to the MASLD nomenclature has not been universally accepted, and its abrupt adoption
could lead to confusion in both research and clinical practice. Although MASLD is supported by major
international scientific societies , there are still divided opinions regarding its universal application [73,74] .
[7]
Some authors have suggested that the primary objective of the consensus process behind the MASLD
definition may have been to resist the original proposal to adopt MAFLD [75,76] . In fact, the Asian Pacific
Association for the Study of the Liver (APASL) continues to support the MAFLD definition, and a recent
[77]
global multi-society endorsement has advocated for MAFLD as an appropriate term . However, these
controversies are of greater academic interest than clinical relevance and should not detract from the
primary goals of raising awareness about this liver disease, ensuring its early identification, and promoting a
multidisciplinary approach to its management.

This ongoing debate underscores the need for flexibility in adopting MASLD, particularly in clinical and
research contexts where the term “steatotic” may not be fully understood or accepted. A flexible approach is
essential to ensure that the adoption of MASLD does not cause unnecessary confusion, especially in settings
where cultural and linguistic barriers may influence the understanding of the terminology.

One of the primary challenges in adopting MASLD lies in its implementation across different countries,
where resistance to changes in established terminology may occur. This highlights the importance of
educating both healthcare professionals and patients about the benefits of the new nomenclature and its
clinical implications. Additionally, the transition must be carefully managed to prevent misunderstandings,
particularly in coding systems such as the ICD, which will require timely updates to reflect these changes.

To facilitate this transition, a structured approach is required across multiple levels of healthcare. Table 1
summarizes key strategies to ensure a smooth implementation of MASLD, focusing on education,
standardization, public health efforts, and adaptation for resource-limited settings.

ADAPTING SLD FOR THE FUTURE
The Delphi consensus statement recognized that MASLD and SLD terminology could dynamically evolve
with emerging knowledge about the condition . It is well established that MASLD exhibits significant
[7]
heterogeneity, with its clinical presentation and course influenced by various factors, including
cardiovascular, metabolic, and neoplastic complications . Consequently, this condition does not follow a
[78]
singular pathogenic, evolutionary, or therapeutic trajectory. For this reason, we believe it would be
advantageous to reconsider the “D” in the nomenclature as “Disorder”.

This change acknowledges the clinical reality that the term “Disease” may oversimplify the diverse
manifestations and etiologies that define these conditions. “Disorder” better reflects the complexity of
steatotic liver disease, which lacks a single etiology or clinical presentation [Figure 2]. By adopting