Koot B.: MASLD
Today’s ESPGHAN podcast offers the opportunity to become acquainted with the effects of a revision in nomenclature. Decades ago, stout – in both senses – Mormon matrons were vastly offended to learn that the form of steatohepatitis from which they suffered was histopathologically superimposeable upon that owing to ingestion of ethanol to excess ; the Word of Wisdom, a revelation vouchsafed in 1833 to Prophet Joseph Smith, expressly forbids ethanol to members of the Church of Jesus Christ of Latter-Day Saints, and the matrons swore up and down that they had forever been teetotal. The term “non-alcoholic fatty liver disease” thus was born.
In speaking with Dr Bart Koot, of Amsterdam’s Emma Children’s Hospital and the University of Amsterdam Medical Centre, one might think “The diseases don’t change, just the names” – an adage once shared with me as I tried to make sense of some very muddy-seeming older publications. “Non-alcoholic” and “fatty” are felt to be stigmatising nowadays, requiring a name-change or three ; instead of “fatty”, “steatotic liver disease” and “steatohepatitis” have been proposed, adopted, and recommended for use by persons prominent in hepatologic and hepatopathologic work. What about “non-alcoholic” ? Try “metabolic dysfunction-associated steatotic liver disease” (MASLD), subspeciated into instances with at least 1 of 5 cardiometabolic risk factors ; those with no disordered metabolic parameters and no known cause of steatosis now have “cryptogenic steatotic liver disease”. And for those who don’t have pure metabolic dysfunction-associated steatotic liver disease, but instead take a drop now and again : “MASLD alcohol-related / -associated liver disease overlap” (MetALD) is the term to use. (“A drop”, 140–350g EtOH/wk and 210–420g EtOH/wk for females and males, respectively).
This approach to usage will permit more precise understandings of what we talk about when we talk, or write, about steatotic liver disease, and that is salutary. (How long these terms will not themselves be considered stigmatising is an open question.) Whilst the terms have met with general acceptance in the northern hemisphere, of interest is that gastroenterologists in sub-Saharan Africa and in South America are not so enthusiastic – to be fat where most persons are chronically hungry is perhaps favourable, as a characteristic, rather than deprecatory. Will the terms come eventually to be used worldwide ? Time will tell.
Specific aspects relevant to paediatricians are highlighted in the multisociety statement on paediatric steatotic liver disease, cited below. Recommended !
Literature :
Younossi ZM et al. Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease. J Hepatol 2024 Mar 80(3):419-430. doi: 10.1016/j.jhep.2023.11.004. Epub 2023 Nov 18. PMID: 37984709
Rinella ME et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. NAFLD Nomenclature consensus group. Ann Hepatol 2024 Jan-Feb 29(1):101133. doi: 10.1016/j.aohep.2023.101133. Epub 2023 Jun 24. PMID: 37364816
Baumann U et al. Paediatric steatotic liver disease has unique characteristics: A multisociety statement endorsing the new nomenclature. J Pediatr Gastroenterol Nutr 2024 May 78(5):1190-1196. doi: 10.1002/jpn3.12156. Epub 2024 Mar 26. PMID: 38529849
Dr. Koots favourite song: Kleine Jongen - Andre Hazes: https://open.spotify.com/track/0NMvLLGLKKJmSMqQSR38Sx?si=fe4165ebf12f4b84
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