MASLD & MetALD
What's in a Name? Nomenclature, Prevalence, Screening & Management — Based on Kanwal et al., Rinella et al. & 2025 Guidelines
- Understand MASLD and differentiate it from MetALD
- Discuss the prevalence of the different phenotypes of SLD
- Review practical management of MASLD and MetALD
Sections
From NAFLD/NASH to MASLD/MASH
In 2023, a multisociety Delphi consensus panel led by Rinella et al. proposed a new nomenclature for fatty liver disease, replacing the exclusionary "non-alcoholic" terminology with more etiologically precise, inclusive, and patient-friendly names.
MASLD
NAFLD
Metabolic Dysfunction-Associated Steatotic Liver Disease
MASH
NASH
Metabolic Dysfunction-Associated Steatohepatitis
MASLD
Metabolic dysfunction
MetALD
MASLD + ↑ alcohol
ALD
Alcohol-associated
Specific SLD
DILI, genetic, etc.
Cryptogenic
No identified cause
Why the name change?
'Non-alcoholic' was stigmatizing and inaccurate. The new nomenclature emphasizes the metabolic etiology (positive criteria), enables recognition of overlap with alcohol use (MetALD), and aligns with how other metabolic conditions are named. Reference: Rinella et al. Hepatology 2023;78(6):1966-1986.
Key Fact: NAFLD ≈ MASLD
Studies using NHANES and other large datasets show near-complete overlap (Cohen's kappa ~0.97) between NAFLD-defined and MASLD-defined populations. Clinical profiles, non-invasive test thresholds, and long-term outcomes are virtually identical — data from NAFLD studies can be applied to MASLD patients.