The journey to redefine nonalcoholic fatty liver disease (NAFLD) was driven by the need to replace exclusionary and stigmatizing terminology. For the past several decades, NAFLD and nonalcoholic steatohepatitis have been standard terms in hepatology but were criticized due to the oversight of metabolic dysfunction and concerns about stigmatization. In 2020, the term “metabolic dysfunction-associated fatty liver disease” was proposed to address these issues by focusing on metabolic dysfunction instead of the negative terminology [
1-
3]. In late 2021, a coalition of experts from the pan-national liver societies convened to address this issue. Through the modified Delphi method, a consensus was reached to use the term “steatotic liver disease” (SLD) and “metabolic dysfunction–associated steatotic liver disease” (MASLD) as a specific subtype within the broader category [
4,
5]. This change led to a paradigm shift in the understanding of liver disease, promoting holistic patient care and paving the way for better health outcomes worldwide [
6,
7].
In Korea, a similar initiative was undertaken by the Korean Association for the Study of the Liver (KASL) to echo this change in nomenclature [
8,
9]. Recognizing the importance of a unified and accurate nomenclature, the KASL decided in December 2023 to establish new terminology for fatty liver disease and to translate it into Korean. In February 2024, KASL launched a dedicated task force to address the nomenclature issue. This task force, composed of eight leading Korean experts in hepatology, aimed to create a Korean term that accurately reflects the nature of fatty liver disease while minimizing stigma and improving patient understanding. The task force began by surveying KASL members to gather their opinions on the current terminology and suggestions for the new nomenclature. This comprehensive survey was designed to assess the recognition of existing terms and identify any cultural or linguistic nuances influencing the new terminology. The survey included questions on whether to emphasize the term “metabolic dysfunction” and, if so, options for appropriate Korean and English terms. Although the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver proposed using “steatotic” instead of “fatty,” the two terms are translated into an identical term, “지방(脂肪),” in Korean. Thus, the survey focused on whether to remove “비알코올” (nonalcoholic, 非酒精) and emphasize “대사이상” metabolic dysfunction, 代謝異常) with the aim to accurately convey the disease’s nature without stigmatizing patients.
In response to these findings, the task force proposed several new terms focusing on descriptors highlighting the metabolic aspect of the disease. After extensive discussions and revisions, the task force converged on the term “대사이상 지방간질환” MASLD, 代謝異常脂肪肝疾患), aligning with the international consensus while ensuring cultural and linguistic relevance. To finalize the new nomenclature, the task force conducted additional rounds of feedback, incorporating input from the 2024 KASL Clinical Practice Guidelines Committee for SLD and the KASL Board of Directors. This iterative process ensured that the new term was scientifically accurate, easy to understand, and stigma-free. The end product of these efforts was presented on June 27, 2024, during The Liver Week 2024. At this event, the KASL announced its position statement on the new nomenclature for fatty liver disease, including the official Korean terminology. By aligning with the global movement toward accurate and inclusive nomenclature, Korea has made significant progress toward enhancing patient care and increasing disease awareness. The new Korean term “대사이상 지방간질환” (MASLD, 代謝異常脂肪肝疾患) reflects a deeper understanding of the disease’s metabolic roots and aims to reduce the stigma long associated with nonalcoholic and “fatty.” The effort to establish this new terminology has been collaborative and thoughtful, one that was driven by a commitment to improve patient outcomes and foster a more compassionate healthcare environment. We expect our actions will have a significant influence on various aspects of disease management, including facilitation of novel drug and biomarker development, reduction of stigma for patients, and promotion of disease awareness among diverse stakeholders such as academic societies, government organizations, policymakers, the medical industry, and patient groups. The adoption of this revised nomenclature by the KASL is a testament to the power of words to shape our understanding of liver disease and the importance of a unified global effort in the fight against it [
10].
FOOTNOTES
-
Authors’ contribution
The NAFLD Nomenclature Revision Consensus Task Force on behalf of the KASL (Alphabetical order).
Byoung Kuk Jang, Dae Won Jun, Sang Gyune Kim, Seung up Kim, Won Kim, Sung Won Lee, Ju Hyun Shim, Su Jong Yu. All authors participated in conceptualization, writing, review and editing.
-
Conflicts of Interest
The authors have no conflicts to disclose.
Abbreviations
nonalcoholic fatty liver disease
metabolic dysfunction-associated steatotic liver disease
Korean Association for the Study of the Liver
REFERENCES
- 1. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol 2020;73:202-209.
- 2. Eslam M, Sanyal AJ, George J; International Consensus Panel. MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology 2020;158:1999-2014.e1.
- 3. Eslam M, Sarin SK, Wong VW, Fan JG, Kawaguchi T, Ahn SH, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Hepatol Int 2020;14:889-919.
- 4. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023;78:1966-1986.
- 5. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023;79:1542-1556.
- 6. Kim GA, Moon JH, Kim W. Critical appraisal of metabolic dysfunction-associated steatotic liver disease: Implication of Janus-faced modernity. Clin Mol Hepatol 2023;29:831-843.
- 7. Yoon EL, Jun DW. Waiting for the changes after the adoption of steatotic liver disease. Clin Mol Hepatol 2023;29:844-850.
- 8. Kang SH, Lee HW, Yoo JJ, Cho Y, Kim SU, Lee TH, et al. KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease. Clin Mol Hepatol 2021;27:363-401.
- 9. Gofton C, Upendran Y, Zheng MH, George J. MAFLD: How is it different from NAFLD? Clin Mol Hepatol 2023;29(Suppl):S17-S31.
- 10. Cho JY, Sohn W. The growing burden of non-alcoholic fatty liver disease on mortality. Clin Mol Hepatol 2023;29:374-376.
Citations
Citations to this article as recorded by
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Clinical and Molecular Hepatology.2025; 31(Suppl): S1. CrossRef - Metabolic Dysfunction-Associated Steatotic Liver Disease, Recent Revision of Terminology and Its Implications
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