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“Disorders”, the nomenclature would expand to include all conditions associated with hepatic steatosis,
ranging from genetic to metabolic, and environmental factors. This adaptation would more accurately
reflect the multifaceted nature of steatotic liver disease, thereby promoting advances in hepatology research
and education. It could also facilitate the development of more specific clinical guidelines tailored to the
diverse presentations and needs of these patients.

We do not propose an immediate change to the nomenclature, as additional modifications may impede the
widespread awareness required for this condition. However, when the necessary debate for the introduction
of this new nomenclature in the ICD takes place, involving national and regional regulatory bodies and the
World Health Organization (which maintains and updates the ICD system), why not adapt it with a
minimal change, from “Disease” to “Disorder”? This simple proposal would make the term SLD truly serve
as an umbrella for all disorders characterized by hepatic steatosis.

CONCLUSION
The transition from NAFLD to MASLD represents a significant advancement in the nomenclature of
steatotic liver diseases, introducing a more inclusive and clinically relevant framework. By emphasizing
metabolic dysfunction as a central criterion, MASLD captures the complex interplay of metabolic,
cardiovascular, and environmental factors in disease progression, enhancing risk stratification and enabling
more personalized patient management. This shift aligns clinical practice with the evolving knowledge of
steatotic liver diseases, offering opportunities to improve patient outcomes and foster global research
collaboration. However, the adoption of MASLD is not without challenges. To better understand the impact
of this transition, Table 2 summarizes the key advantages and challenges associated with the different
nomenclatures. This comparison highlights the strengths and limitations of each nomenclature, providing
insight into the rationale for the recent shift to MASLD and the challenges that remain for its full
implementation. Cultural and linguistic differences, as well as the need to educate healthcare professionals
and patients, have emerged as significant hurdles. Additionally, integrating MASLD into international
coding systems such as the ICD requires careful planning to address ongoing debates, such as defining
alcohol consumption thresholds for differentiating MetALD and MASLD. These challenges underline the
importance of continued efforts to refine and standardize the application of the new nomenclature.

MASLD marks a critical step forward in advancing the diagnosis and management of steatotic liver disease.
Overcoming current obstacles through global cooperation, education, and research will be essential to fully
realize its potential in improving clinical care and public health worldwide.