By Dr. Vishnu Girish, MD, DM | Hepatologist in Kochi
Patients often come back to my clinic confused after a repeat scan or blood test. This confusion around the MASLD fatty liver diagnosis is common.
“Doctor, last year my report said fatty liver disease, NAFLD. This year it says MASLD. Do I have a new problem?”
The honest answer is no, not a new problem, mostly a new name. In June 2023, the major liver societies of the world, the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Latin American liver association, agreed on a global renaming of fatty liver disease. Non-alcoholic fatty liver disease, or NAFLD, became MASLD, short for metabolic dysfunction associated steatotic liver disease. Its more advanced form, NASH, became MASH.
This was not a cosmetic change made for the sake of it. The old name, non-alcoholic, defined the disease by what it was not, which is clinically imprecise and, for many patients, quietly stigmatising. It suggested the diagnosis was somehow about the absence of alcohol, when the real driver in most patients is metabolic dysfunction: insulin resistance, obesity, high blood pressure, or abnormal cholesterol. The new name describes what the disease actually is, rather than what it excludes.
What MASLD requires that NAFLD did not for fatty liver
Under the new definition, a diagnosis of MASLD requires fat in the liver plus at least one of five cardiometabolic risk factors, things like elevated waist circumference, high blood pressure, high blood sugar, or abnormal lipid levels. In practice, around 99 percent of patients who previously met criteria for NAFLD also meet criteria for MASLD, so for almost everyone reading an old report, this is genuinely the same condition under a new label.
“When a patient asks if this new name means their disease has changed, I tell them their liver has not changed at all. Only how precisely we describe it has changed.”
One genuinely useful addition in this update is a new category called MetALD, for people who have metabolic risk factors and also drink alcohol at moderate levels, more than the old NAFLD definition allowed but less than what would be called pure alcohol related liver disease. This matters in Kerala, where alcohol consumption is common and many patients sit in this overlapping zone rather than a clean either-or category. The new nomenclature finally gives this group its own recognised diagnosis instead of forcing them into one box or the other.
“A lot of patients in Kerala do not fit neatly into ‘only diet’ or ‘only alcohol.’ MetALD finally gives that overlap a name and, more importantly, a reason to be taken seriously.”
For patients, the practical takeaway is simple: if your report now says MASLD instead of NAFLD, or MASH instead of NASH, your management does not need to change because of the name. Screening, monitoring for fibrosis with tools like FibroScan, weight management, and control of blood sugar and cholesterol remain exactly as important as before. What has changed is that doctors now have a more accurate and less stigmatising language to discuss your liver health with you.
Frequently Asked Questions
Q: Is MASLD a more serious condition than NAFLD?
No, they describe essentially the same disease in most patients. MASLD is simply a more precise, updated name that reflects the metabolic causes behind the fat in the liver.
Q: What does MetALD mean and does it apply to me?
MetALD describes patients who have metabolic risk factors along with moderate alcohol intake, more than pure MASLD allows but less than alcohol-associated liver disease. Your liver specialist in Kochi can help determine which category best fits your history.
Q: Do I need new tests just because the terminology changed?
Not necessarily. Existing tests like liver enzymes, ultrasound, and FibroScan remain valid tools for monitoring MASLD, and your treatment plan is based on your actual liver findings, not the name on the report.
Q: Should I see a hepatologist in Kochi if my report now says MASLD?
If you have MASLD with elevated liver enzymes, diabetes, or suspected fibrosis, consulting a liver specialist in Kochi is worthwhile for proper risk assessment and monitoring.
Q: Can I discuss my updated fatty liver report over an online consultation?
Yes, Dr. Vishnu Girish offers online consultation for patients across Kerala and India who want their fatty liver reports and terminology explained clearly.
Dr. Vishnu Girish is a hepatologist and liver specialist based in Kochi, Kerala. He offers in-person consultations at his hepatology clinic in Kochi and online consultations for patients across India. Visit liverbyvishnu.com