Gastroenterology & Nutrition

MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease)

Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) is hepatic steatosis with cardiometabolic risk; most people are asymptomatic, so the clinical priority is identifying advanced fibrosis and reducing liver and cardiovascular risk.

Definition

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), is hepatic steatosis in the context of one or more cardiometabolic risk factors. Metabolic and alcohol-related contributors can overlap; the phenotype spans isolated steatosis, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis and cirrhosis.

First principles

MASLD is a metabolic and liver disease

Insulin resistance, dysglycaemia, obesity, hypertension and dyslipidaemia alter fatty-acid delivery, hepatic lipogenesis and lipid handling, leading to hepatic steatosis. The current MASLD terminology recognises steatosis with cardiometabolic risk; alcohol-related and metabolic contributors may overlap, so alcohol history remains essential rather than being treated as an exclusion afterthought.

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