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Background <p>&#xa0;Chronic liver disease related to metabolic dysfunction affects approximately 30–38% of adults worldwide. For decades termed non-alcoholic fatty liver disease (NAFLD) a diagnosis of exclusion this condition was redefined in 2023 as metabolic dysfunction-associated steatotic liver disease (MASLD) through an international multisociety Delphi consensus. This review examines the implications of this nomenclature transition.</p> Objective <p>To evaluate how the redefinition from NAFLD to MASLD has influenced disease understanding, diagnosis, risk stratification, and clinical management, while identifying remaining implementation challenges and research gaps.</p> Key findings <p>The transition to MASLD addresses critical limitations of the NAFLD framework by: (1) replacing exclusion-based criteria with positive diagnostic criteria centered on cardiometabolic risk factors; (2) potentially reducing stigma associated with "alcoholic" terminology, though patient perceptions vary significantly across regions; (3) aligning disease definition with underlying pathophysiology; and (4) facilitating interdisciplinary care models. Epidemiological studies demonstrate that MASLD criteria identify a similar but more metabolically characterized population. Non-invasive diagnostic tools including FIB-4, FibroScan, and MRI-PDFF have enhanced early detection, though access disparities persist. Pathophysiologically, MASLD represents a multisystem disorder driven by insulin resistance, lipotoxicity, adipose tissue dysfunction, genetic susceptibility (PNPLA3, TM6SF2, MBOAT7 variants), and gut-liver axis alterations. Management strategies emphasize lifestyle interventions targeting ≥ 5–10% weight loss, with emerging pharmacotherapies including resmetirom (FDA-approved for MASH with F2-F3 fibrosis), GLP-1 receptor agonists, and combination approaches. However, evidence that terminology change alone improves clinical outcomes remains preliminary.</p> Conclusion <p>The MASLD redefinition represents a conceptually important shift toward biologically grounded, patient-centered nomenclature that positions fatty liver disease within metabolic health. Successful implementation requires updated clinical guidelines, healthcare provider education, electronic health record modifications, and continued prospective research into personalized prevention and treatment strategies. Unresolved issues include optimal screening intervals, real-world effectiveness of terminology change, and global implementation harmonization.</p>

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Clinical pathophysiological and health system implications of the transition from NAFLD to MASLD: a narrative review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月30日

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  • Eslam Abady,
  • Hazem AbuEl-Enien,
  • Karrar Naem Karam,
  • Sarim Hassan Shahab,
  • Sarah Fakhiraldeen,
  • Pari Kotak,
  • Yahya Samadi,
  • Zarqa Yasin

摘要

Background

 Chronic liver disease related to metabolic dysfunction affects approximately 30–38% of adults worldwide. For decades termed non-alcoholic fatty liver disease (NAFLD) a diagnosis of exclusion this condition was redefined in 2023 as metabolic dysfunction-associated steatotic liver disease (MASLD) through an international multisociety Delphi consensus. This review examines the implications of this nomenclature transition.

Objective

To evaluate how the redefinition from NAFLD to MASLD has influenced disease understanding, diagnosis, risk stratification, and clinical management, while identifying remaining implementation challenges and research gaps.

Key findings

The transition to MASLD addresses critical limitations of the NAFLD framework by: (1) replacing exclusion-based criteria with positive diagnostic criteria centered on cardiometabolic risk factors; (2) potentially reducing stigma associated with "alcoholic" terminology, though patient perceptions vary significantly across regions; (3) aligning disease definition with underlying pathophysiology; and (4) facilitating interdisciplinary care models. Epidemiological studies demonstrate that MASLD criteria identify a similar but more metabolically characterized population. Non-invasive diagnostic tools including FIB-4, FibroScan, and MRI-PDFF have enhanced early detection, though access disparities persist. Pathophysiologically, MASLD represents a multisystem disorder driven by insulin resistance, lipotoxicity, adipose tissue dysfunction, genetic susceptibility (PNPLA3, TM6SF2, MBOAT7 variants), and gut-liver axis alterations. Management strategies emphasize lifestyle interventions targeting ≥ 5–10% weight loss, with emerging pharmacotherapies including resmetirom (FDA-approved for MASH with F2-F3 fibrosis), GLP-1 receptor agonists, and combination approaches. However, evidence that terminology change alone improves clinical outcomes remains preliminary.

Conclusion

The MASLD redefinition represents a conceptually important shift toward biologically grounded, patient-centered nomenclature that positions fatty liver disease within metabolic health. Successful implementation requires updated clinical guidelines, healthcare provider education, electronic health record modifications, and continued prospective research into personalized prevention and treatment strategies. Unresolved issues include optimal screening intervals, real-world effectiveness of terminology change, and global implementation harmonization.