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Anand et al. Metab Target Organ Damage. 2025;5:20 https://dx.doi.org/10.20517/mtod.2025.18 Page 3 of 5

[21]
in children when various inborn errors of metabolism commonly manifest as steatosis .

This latest nomenclature has also come under criticism, with experts quickly highlighting its
limitations [20,22] . The Delphi consensus voting pattern showed that the term MASLD failed to reach the
Delphi target of 67% (as it was the top choice of only 30% of experts) but was still accepted as a consensus.
Some have suggested that the entire exercise may have been done to save billions of dollars already invested
in biomarker and drug treatment research for NAFLD, as the earlier definition of MAFLD would have
classified 20% of patients differently [23,24] . MASLD primarily focuses on liver fat, which may eventually be
replaced by fibrosis as the disease progresses to cirrhosis. In such cases, patients without detectable fat in the
liver may be mistakenly labeled as having cryptogenic cirrhosis. One major challenge in MASLD was the
inclusion and stratification of alcohol intake, which largely relies on patient self-reported history. However,
this approach is inherently unreliable, as patients may either misrepresent or underestimate their alcohol
consumption . Additionally, no effort was made to stratify the degree of metabolic dysfunction - an
[25]
individual with only one cardiometabolic risk factor (CMRF) is considered equivalent to someone with five
CMRFs.

This raises a fundamental question. How has this change in nomenclature improved our understanding or
management of the condition? Whatever the name, patients will continue to progress from fatty liver to
steatohepatitis, then to fibrosis, and ultimately to either cirrhosis or HCC. Is the new nomenclature truly
evidence-based? A large number of papers have discussed the pros and cons of this change in recent
years [10,26,27] . Now, efforts are being made to collect evidence to justify the revised terminology, and initial
[28]
findings are yielding intriguing insights . Perhaps the same level of enthusiasm should be directed toward
addressing clinical questions that may directly impact patient outcomes.

DECLARATIONS
Authors’ contributions
Involved in the manuscript preparation and contributed equally: Anand AC, Praharaj D
Read and approved the manuscript: Anand AC, Praharaj D

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2025.