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Non-alcoholic fatty liver disease (NAFLD) has recently been renamed MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease), reflecting a shift in understanding of the disease's root causes and its broader implications.

Why the Name Change?

• The primary reason for renaming NAFLD to MASLD is to highlight the metabolic dysfunction as the primary cause of the disease.
• Previously, the term NAFLD focused on the absence of alcohol consumption, which inadvertently shifted attention away from the true contributors, like obesity, type 2 diabetes, and abnormal cholesterol levels.
• The term MASLD eliminates the stigma associated with "non-alcoholic," which may have misled people into thinking alcohol consumption was the only factor, even though metabolic issues are the central cause.
• The term MASLD shifts the focus towards metabolic dysfunction, making it easier for healthcare professionals to understand, diagnose, and treat the condition more effectively.

The Connection to Metabolic Dysfunction

• MASLD is strongly associated with metabolic issues such as abdominal obesity, insulin resistance, and high blood sugar. These metabolic problems are key contributors to liver fat accumulation.
• People with abdominal obesity are 2-3 times more likely to develop fatty liver disease. MASLD affects about 25% of the global population, and the rates increase significantly (up to 50-70%) in individuals with type 2 diabetes or obesity.
• By focusing on metabolic dysfunction, MASLD encourages addressing the root causes rather than just the symptoms, offering a more effective approach to treatment and prevention.

How is MASLD Diagnosed?

Advancements in non-invasive diagnostic methods have improved the ability to diagnose MASLD more easily and accurately, including:

• FibroScan: A non-invasive, painless test to measure liver fat and stiffness, replacing the need for liver biopsy.
• MRI and Ultrasound Techniques: Reliable methods for assessing liver fat and scarring.
• Blood Tests: Common tests like ALT, AST, and GGT assess liver function. Researchers are also exploring new markers like CK-18 fragments and the ELF score (Enhanced Liver Fibrosis) to improve diagnostic accuracy.

Implications for Patient Care

The renaming of NAFLD to MASLD has important implications for patient care:

• Targeted Treatments: By focusing on the metabolic roots, treatments such as weight loss, blood sugar management, and cholesterol control can be prioritized. These interventions help reduce the risk of long-term complications such as heart disease, liver failure, and cirrhosis.
• Earlier Diagnosis: MASLD encourages earlier recognition of the condition, which can lead to better management and improved long-term outcomes.

Prevention

Preventing MASLD involves avoiding foods that exacerbate liver fat buildup. Dr. Punit Singla, director at Marengo Asia Hospitals, emphasizes limiting or avoiding:

• Fast food, junk food, and processed foods
• Foods high in sugar, including red and processed meats

A healthier lifestyle with a balanced diet rich in whole grains, fruits, vegetables, and lean proteins can significantly help prevent or manage MASLD.