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Sanal et al. Metab Target Organ Damage 2024;4:45 https://dx.doi.org/10.20517/mtod.2024.54 Page 7 of 11

NEED FOR A CRITERIA WHICH IS OF PUBLIC HEALTH UTILITY
“Steatosis” like “hepatitis” - is considered as a histological diagnosis. While MAFLD can be a clinical
diagnosis, MASLD cannot because steatosis needs to be established by histopathology. This would be
important from a public health perspective, especially for mass diagnosis and for various epidemiological
association studies where a liver biopsy is not possible either because of resource constraints, associated
risks, or ethical concerns. Additionally, the non-invasive markers of non-alcoholic steatohepatitis (NASH)
and liver cirrhosis are slowly improving, which makes liver biopsy less justifiable.

Even if one could argue that newer ultrasound equipment can detect steatosis with reasonable efficiency, the
gold standard remains histological. The use of the term “steatotic” could also cause further confusion from
this perspective. The severity of steatosis can be graded based on the percentage of hepatocytes containing
fat. The grading of steatosis is mild (Grade 1) when less than 33% of hepatocytes are affected, moderate
(Grade 2) when 34% to 66% of hepatocytes are affected, and severe (Grade 3) when more than 66% of
hepatocytes are affected can be decided only by histology .
[27]

APPRAISING THE EVIDENCE: MAFLD HAS THE EDGE
From the perspective of a screening tool, MAFLD captures the mortality and morbidity in a population
[28]
better than MASLD, especially because it gives due importance to metabolic and adiposity risk factors .
MAFLD is also proven to be highly effective in identifying individuals at elevated risk for metabolic
[29]
complications and a range of liver and non-liver diseases . In addition, MAFLD criteria are better than
MASLD at predicting the risk of chronic kidney disease and identifying individuals who have both fatty
[30]
liver and significant fibrosis when assessed using non-invasive tests . Finally, the MASLD definition, when
[31]
used in children, is flawed, underscoring the advantages of the consensus criteria for pediatric MAFLD [29,32] .
To summarize, based on published evidence, the MASLD criteria fall short in comparison to the MAFLD
criteria [Table 1].

BALANCING ACCURACY AND ACCESSIBILITY
Finding a balance between scientific accuracy and accessibility in disease naming is crucial for effective
communication in the medical field. While using common language can enhance understanding among the
wider public, certain medical terminology is indispensable for precise communication by healthcare
professionals and researchers, such as the terms fatty liver or fatty streaks or fatty pancreas.

One of the primary considerations in disease naming is ensuring that the terminology is accessible to the
public. Using language that is easily understood by patients and the broader community fosters clear
communication between healthcare providers and individuals seeking medical information. For example,
replacing complex scientific terms with simpler, more familiar language can help patients grasp the nature
of their condition and the recommended treatment options. This approach promotes patient education and
empowers individuals to make informed decisions about their health.

However, it is also important to recognize the necessity for scientific accuracy in disease naming. Certain
medical terms, rooted in Latin or Greek origins, convey specific meanings that are essential for precise
diagnosis and treatment. While common language may provide accessibility, it may not always capture the
nuanced characteristics of a disease. For instance, replacing the term “NAFLD” with a simplified version
may sacrifice the specificity needed for accurate medical diagnosis and management.