Progress is impossible without change: understanding the evolving nomenclature of steatotic liver disease and its effect on hepatology practice

Paul N Brennan; Oliver D Tavabie; Wenhao Li; Thomas Marjot; Lynsey Corless; Jonathan A Fallowfield; Helen Jarvis; Dina Mansour; Stuart McPherson; William Rosenberg; Karen Rockell; Jeremy Tomlinson; Andrew Yeoman; Emmanuel A Tsochatzis; John F Dillon; William Alazawi; Kushala W M Abeysekera

doi:10.1016/S2468-1253(23)00453-3

Progress is impossible without change: understanding the evolving nomenclature of steatotic liver disease and its effect on hepatology practice

Lancet Gastroenterol Hepatol. 2024 Jun;9(6):577-582. doi: 10.1016/S2468-1253(23)00453-3. Epub 2024 Feb 28.

Authors

Paul N Brennan¹, Oliver D Tavabie², Wenhao Li³, Thomas Marjot⁴, Lynsey Corless⁵, Jonathan A Fallowfield⁶, Helen Jarvis⁷, Dina Mansour⁸, Stuart McPherson⁹, William Rosenberg¹⁰, Karen Rockell¹¹, Jeremy Tomlinson⁴, Andrew Yeoman¹², Emmanuel A Tsochatzis¹⁰, John F Dillon¹, William Alazawi³, Kushala W M Abeysekera¹³

Affiliations

¹ Division of Clinical and Molecular Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
² Leeds Liver Unit, St James's University Hospital, Leeds, UK.
³ Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK.
⁴ Oxford Centre for Diabetes Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK.
⁵ Department of Gastroenterology, Hepatology and Endoscopy, Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, Hull, UK.
⁶ Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK.
⁷ Population Heath Sciences Institute, Newcastle University, Newcastle, UK.
⁸ Department of Gastroenterology and Hepatology Queen Elizabeth Hospital, Gateshead and Translational and Clinical Research Institute, Newcastle University, Newcastle, UK.
⁹ Liver unit, The Newcastle upon Tyne Hospital NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle, UK.
¹⁰ UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
¹¹ UK Organ Donation and Transplantation Research Network, UK.
¹² Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK.
¹³ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: [email protected].

PMID: 38428439
DOI: 10.1016/S2468-1253(23)00453-3

Abstract

The American, European, and Latin American liver societies have proposed a change in the nomenclature we use to describe alcohol-related liver disease and non-alcoholic fatty liver disease. Additionally, a term encompassing both is now advocated: steatotic liver disease, which includes metabolic dysfunction associated steatotic liver disease (MASLD) and MASLD with greater alcohol consumption (MetALD). These classifications offer increased relevance for clinicians, researchers, and patients alike. In this Viewpoint, we discuss the basis for this nomenclature shift and how it was developed. We also explore the challenges that will be faced in the adoption of such change. The proposed change seeks to banish stigma associated with phrasing such as alcoholic and fatty. However stigma, particularly related to the term fatty, is culturally nuanced, and reflects different entities depending on location. If such a change is internationally accepted, there will be wide-reaching effects on practitioners in primary care and metabolic medicine, and on patients. We discuss those effects and the opportunities the nomenclature change could offer, particularly for patients with alcohol and metabolic risk factors who represent a group previously ignored by clinical trials.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Fatty Liver / classification
Fatty Liver, Alcoholic / classification
Gastroenterology
Humans
Non-alcoholic Fatty Liver Disease / classification
Risk Factors
Social Stigma
Terminology as Topic*

Grants and funding

MR/V037331/1/MRC_/Medical Research Council/United Kingdom