Importance of the new steatotic liver disease nomenclature

Steatotic liver disease (SLD) is an umbrella term that encompasses five subtypes: metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), alcohol-related liver disease (ALD), steatotic liver disease of other etiologies, and cryptogenic steatotic liver disease. MASLD is the current term used to describe hepatic steatosis in the presence of at least one metabolic risk factor. It is a public health problem, as it is estimated to affect up to 38% of the general population. This underscores the importance of having an adequate and refined classification for the disease. In 2023, it was proposed to replace the term nonalcoholic fatty liver disease (NAFLD) with MASLD, as the latter better reflects the pathophysiology of the disease, avoids stigmatization by removing the terms “alcohol” and “fatty,” and establishes a positive diagnosis rather than one based on exclusion. These changes provide advantages in both clinical practice and research, while also allowing patients to better understand their condition, which may translate into greater treatment adherence and empowerment. The new terminology also acknowledges patients with metabolic risk factors who additionally present significant alcohol consumption, introducing the concept of MetALD. In this subgroup, emphasis is placed both on the management of metabolic comorbidity and on the reduction of alcohol intake. Overall, this nomenclature change represents a relevant effort to address a highly prevalent disease, although there remain areas of opportunity that will need to be refined over time to optimize our patient´s management and treatment.