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across the Atlantic. Should we advocate for renaming the unit of force due to this historical association?
There is a heightened sensitivity these days around race, gender, appearance, and so on, which is sometimes
engineered and exploited by people with vested interests. The effects include removing historic structures
[10]
and statues , altering eponyms (e.g., Wegener’s granulomatosis) [11,12] , medical terms (consumption for
tuberculosis) , etc.
[13]
The renaming of fatty liver disease, the transition from NAFLD to MAFLD, is grounded in objective
criteria, focusing on underlying metabolic dysfunction and fat accumulation in the liver. However, a change
to MASLD appears subjective and imperative.

Some argue it aims to reduce stigma without clear supporting evidence. The term “NON-ALCOHOLIC
fatty liver disease” explicitly indicates the absence of alcohol consumption, and as alluded to earlier, the
amount of drinking and its cut-offs are arbitrary and cannot be arbitrated upon, but rather require evidence.
MASLD may be attributed to a genre of political correctness, characterized by heightened sensitivity to
prejudice, sometimes surpassing logical reasoning. Claims of body shaming due to the term “fatty” in
NAFLD or MAFLD are considered symptomatic of this sensitivity. It is even more true since the term “fatty
liver” does not refer to one’s external appearance but to the presence of fat in an internal organ. Contrary to
assumptions, India has the highest number of fatty liver patients globally, attributed to its status as the
diabetes capital. In India, obesity is not stigmatized, and moderate obesity is often perceived as healthy and
appealing. Unfortunately, in the survey , patient and geographical representation especially from the most
[1]
populated continents (and those harboring the greatest burden of liver disease) - Asia and Africa was poor
and this fact generated a predictable reaction [14-20] .

Irrespective of regional differences, clarity in communication remains crucial. Communication between
doctors and patients should not leave any kind of ambiguity. When discussing medical conditions such as
fatty liver disease with patients, it is critical that healthcare professionals use language that is clear, concise
and easy to understand. This includes avoiding jargon or technical terms that may be unfamiliar to patients.
In the West and other parts of the world, when communicating with patients, it is common practice to tell
patients they have a fatty liver, as most would not understand the term “steatotic”.

FATTY LIVER DISEASE: MERELY A PRACTICAL DIAGNOSIS
Diagnosing fatty liver disease is a nuanced and practical challenge from both scientific and clinical
perspectives. It is particularly difficult to disentangle and evaluate the relative and independent
contributions of various aetiologies that lead to the accumulation of fat in the liver. The main contributing
factors include metabolic syndrome (specifically insulin resistance), alcohol consumption, and viral
infections [3,6,21-26] .

Determining the extent to which each factor - alcohol intake, insulin resistance, or infection -contributes to
the presence of fat and inflammation in the liver is especially challenging when a patient presents with
multiple potential causes. This complexity arises because these factors can interact in ways that are not yet
fully understood, making it hard to pinpoint their individual impacts.

One positive development is the effective treatment of viral aetiologies, which has led to a decrease in liver
fat due to viral infections. However, this progress does not extend to alcohol-related liver disease, as excess
alcohol consumption remains a significant and persistent problem. Additionally, it is important to
recognize that a substantial amount of alcohol is produced endogenously within our bodies , and the role
[5]
of this internal alcohol production in contributing to fatty liver disease is currently not well understood.