Effervescent Invigorating Andrews Liver Salt

Is This Liver Fatty or Steatotic? Does It Matter?

By the end of this month, we will be seeing lists of what’s in and what’s out for the coming year. For people whose minds drift toward liver disease, we have an entry. Fatty liver is out and steatotic liver is in. NAFLD goes to the dustbin, replaced by MASLD, while MASH takes over from NASH. In case you need a glossary for all these acronyms, here goes:

NAFLD = Non-Alcoholic Fatty Liver Disease
MASLD = Metabolic dysfunction Associated Steatotic Liver Disease
NASH = Non-Alcoholic SteatoHepatitis
MASH = Metabolic dysfunction Associated SteatoHepatitis
MetALD = Metabolic and Alcohol-related Liver Disease

That last one, MetALD, is a totally new category of liver disease to account for cases where both alcohol and metabolic dysfunction contribute to steatotic liver disease.

Stigma Is the Problem

You might ask what prompted all this change and a new paper in the Journal of Hepatology has the answer. It’s stigma, which gets in the way of dealing with liver disease. Zobair Younossi and colleagues surveyed patients and healthcare providers all over the world to understand the stigma attached to NAFLD.

They found evidence of stigma in both professionals and patients, with some important differences. Stigma among patients was evident because more than half (52%) never even disclosed their condition to family or friends. Since 38% of the world’s population has what we now call MASLD, it is a problem that nobody wants to talk about it.

The study also indicated that professionals are uncomfortable with the terminology that embeds “fatty” and “nonalcoholic” in the nomenclature for this disease. They were more uncomfortable with this part of it than patients were. For patients, the biggest problem is the tie-in to obesity, which is highly stigmatized, especially in the U.S.

Language Shapes Our Response to Metabolic Disease

Language is important. When health professionals apply stigmatizing labels to patients and conditions, they betray and reinforce bias. Or they may avoid talking about it. We sometimes encounter people who have no patience for choosing neutral terminology. But they are missing the importance of language.

Words can wound and words can heal. The choice is one that we all make every day – whether we think about it or not.

Click here for the study of terminology in metabolic liver disease and here for the international consensus on nomenclature. For perspective on how language frames and shapes our response to obesity, click here, here, and here.

Effervescent Invigorating Andrews Liver Salt, photograph by Kenneth Allen, licensed under CC BY-SA 2.0

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December 4, 2023

One Response to “Is This Liver Fatty or Steatotic? Does It Matter?”

  1. December 05, 2023 at 8:55 am, Ds said:

    Metabolic and alcohol-related liver disease (MAFLD) is a spectrum of liver conditions that can range from fatty liver (steatosis) to inflammation (steatohepatitis) to fibrosis and cirrhosis. MAFLD is the most common cause of chronic liver disease worldwide, affecting up to 30% of adults.