The liver is an essential organ responsible for multiple bodily functions, such as blood detoxification, metabolism, and nutrient storage. The liver breaks down toxins, aids in digestion, produces bile to absorb fat, and provides a storage place for fat-soluble vitamins.  

Although the liver can regenerate after being injured, it is still vulnerable to harmful diseases and exposures that can damage it beyond repair.

For more than 40 years, health professionals have called the two most common liver diseases nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). The last few decades have shown a close and bi-directional association between NAFLD and metabolic syndrome (MetS), suggesting that NAFLD may be a precursor to MetS or the result of pre-existent MetS.

However, the use of “non-alcoholic” in both names has not accurately captured the cause of the disease, and the word “fatty liver” is considered to be a description. Thus, the link between NAFLD and MetS has led the medical community to rename the most common liver diseases to encompass the associated cardiometabolic risk factors and avoid the exclusionary and potentially stigmatizing former terminology.

Let’s dive into the new liver condition vocabulary developed by academic professionals, health-care professionals, regulatory agencies, and patient advocacy organizations, as well as the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. We will also explore how these name changes will drive disease awareness and policy change, identify the individuals at risk to facilitate proper diagnosis, and improve access to care.

Fatty liver disease is now steatotic liver disease

From here forward, fatty liver will be replaced with hepatic steatosis or steatotic liver disease (SLD), a more technical and less stigmatizing term that has the same meaning: that the liver has an excessive amount of fat that is causing hardening. Other factors can also cause SLD, including medications and genetic conditions, as well as unknown reasons. 

NAFLD is now MASLD

An estimated 25-33 percent (100 million) of U.S. adults, 50 percent of dysmetabolic adults, and as much as 38 percent of the global population (~3.1 billion) have what was previously referred to as NAFLD1 – a term now being replaced with metabolic dysfunction-associated steatotic liver disease (MASLD) to include individuals who have hepatic steatosis and at least one of the five main adult risk factors for MetS2:

  • BMI greater than 25 kilograms per meter squared, or a waist circumference greater than 40 inches in men or 35 inches for women or their ethnically adjusted equivalent.
  • Fasting blood glucose greater than 100 mg per deciliter or 2-hour post-load glucose level greater than 140 mg per deciliter, or HbA1c greater than 5.7 percent or type 2 diabetes or treatment for type 2 diabetes.
  • Blood pressure greater than 130 over 85 mmHg or specific anti-hypertensive drug treatment.
  • Plasma triglycerides greater than 150 mg per deciliter or a lipid-lowering treatment.
  • Plasma HDL-cholesterol below 40 mg per deciliter for men or less than 50 mg per deciliter for women or lipid-lowering treatment.

And it should be noted there are different established cardiometabolic criteria for children. 

For women who consume alcohol in amounts greater than 140 grams per week (about 10 drinks) or men who consume greater than 210 grams per week (about 15 drinks), a new liver category was created out of MASLD to include alcohol-related liver disease (ALD) called metabolic dysfunction alcohol-associated liver disease (MetALD). It is possible for an individual to have MASLD, which would be related to metabolic factors, or it could be considered MetALD if the individual consumes above the alcohol standards. 

NASH is now MASH

Metabolic dysfunction-associated steatohepatitis (MASH) now replaces NASH or nonalcoholic steatohepatitis. This new name emphasizes that the condition is not related to alcohol consumption.

The take-home message

The health of your liver has a bi-directional impact on most metabolic systems of the body and organ systems like the gut, skeletal muscles, skin, and lungs.

Some of the biggest risk factors affecting liver health and your risk for MAFLD and MASH are:

  • Current diagnosis of a metabolic disorder, such as obesity, type 2 diabetes, dyslipidemia, and/or hypertension.
  • Excessive or frequent alcohol consumption.
  • Elevated BMI due to visceral fat accumulation. 
  • Sedentary or inactive lifestyle.

Signs of abnormal liver function could include:

  • Elevated levels of certain biomarkers, including liver enzymes, bilirubin, albumin, and/or triglycerides.
  • Abnormal liver imaging tests that show liver stiffness, liver fat, and staging of disease progression.

Tips when discussing the health of your liver with your health-care practitioner

Be honest: Accurately represent your dietary habits, including types, amounts, and categories of foods you eat or avoid; supplement usage, including type, the amount you’re taking, and compliance of consumption; amounts and type of exercise; how many hours are spent sitting daily; and frequency and amount of alcohol consumption. Both good and bad daily habits play an important role in current risk and future liver-health evaluations and treatment plans. 

Get your liver enzymes tested: Blood tests of liver enzymes and metabolic biomarkers help you understand the functioning status of your liver. Be sure to request bloodwork and copies of the results at yearly check-ups. Consider taking Thorne’s Advanced Health Panel, which can be scheduled on your own in between doctor visits and allows you to monitor changes as your diet, weight, medications, and health fluctuate during the year. Going beyond what your health-care practitioner might be testing, the Advanced Health Panel covers all of the metabolic pathways that play a role in liver-health status and includes more advanced and less-often-tested biomarkers, like cholesterol particle number and size, inflammation biomarkers, and fatty acid percentages.

Schedule regular follow-ups: Frequent and consistent visits with your physician will help you stay the course of a treatment plan and monitor and track health changes. Record, track, and report changes in symptoms between visits, as even small signs of other system changes can relate to how the liver is functioning.

Supplement your liver health

Consider the following options that support many of the cardiometabolic risk factors associated with MASLD and MASH:

  • S.A.T. is a liver-protective formula that contains milk thistle and curcumin (both in phytosome form for improved absorption) along with artichoke extract – to provide support for fat metabolism, protect against oxidative stress, and promote a healthy inflammatory response.*
  • Phosphatidyl Choline has been shown in numerous studies to protect liver cells from toxin damage.* Phosphatidyl Choline also exhibits the potential to help maintain normal cholesterol levels.*
  • Metabolic Health provides well-absorbed curcumin and bergamot – in phytosome form – to help maintain a healthy weight by supporting fat metabolism and optimal cholesterol and blood sugar levels.*
  • Berberine supports healthy cholesterol and blood sugar levels, in addition to providing liver-protective benefits.*

References

  1. Pipitone RM, Ciccioli C, Infantino G, et al. MAFLD: a multisystem disease. Ther Adv Endocrinol Metab 2023;14:20420188221145549.
  2. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023;78(6):1966-1986.