NAFLD is Now Called MASLD — Here is What Changed and Why
In 2023, the global hepatology community officially renamed Non-Alcoholic Fatty Liver Disease (NAFLD) to MASLD — Metabolic dysfunction-Associated Steatotic Liver Disease. The rename followed a multi-society consensus (EASL, AASLD, ALEH, APASL) and reflects a more precise understanding of the disease.
Key changes in terminology:
- NAFLD → MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease)
- NASH → MASH (Metabolic dysfunction-Associated Steatohepatitis)
- NAFLD cirrhosis → MASH cirrhosis
The biology is identical. The new name removes the stigmatising “non-alcoholic” label, emphasises the role of metabolic syndrome (obesity, type 2 diabetes, hypertension, dyslipidaemia), and creates a clearer taxonomy for patients who have both metabolic liver disease and some alcohol use.
How Common is MASLD in India?
MASLD is the most common liver disease in India, with prevalence estimated at 25–38% of the adult population based on ultrasound-based surveys. The rising rates of obesity, type 2 diabetes, and sedentary lifestyles are driving a parallel epidemic of fatty liver disease. Importantly, MASLD affects non-obese individuals too — so-called “lean MASLD” — which is particularly prevalent in the Indian subcontinent.
When Does Fatty Liver Become Dangerous?
Most patients with MASLD have simple steatosis (fat accumulation without inflammation) and do not progress to serious liver disease. The danger lies in progression to MASH with fibrosis:
- Simple steatosis (F0–F1): Usually benign; reversible with lifestyle modification
- MASH without significant fibrosis (F1–F2): Mildly elevated risk; lifestyle change and close monitoring
- MASH with advanced fibrosis (F3–F4/cirrhosis): High risk of liver failure, portal hypertension, and hepatocellular carcinoma (HCC). Approximately 10–20% of patients with F3 fibrosis develop cirrhosis over 10 years.
Annual FibroScan (transient elastography) is recommended for all MASLD patients to track fibrosis progression without repeated liver biopsies.
Can Fatty Liver Be Reversed?
Yes — with the right approach:
Lifestyle modification (first-line, most evidence):
- A 7–10% reduction in body weight resolves MASH in most patients and reduces fibrosis by at least one stage in many
- Mediterranean diet: high in vegetables, legumes, whole grains, olive oil, fish; low in added sugar, refined carbohydrates, and saturated fat
- Avoid fructose and sugar-sweetened beverages entirely
- 150–300 minutes of moderate aerobic exercise per week
- Complete alcohol abstinence
Pharmacological options (2024–2025):
- Semaglutide (GLP-1 agonist): Significant evidence for weight loss and MASH resolution
- Resmetirom (Rezdiffra): FDA-approved in March 2024 — the first approved drug specifically for MASH with liver fibrosis (F2–F3). Not yet widely available in India.
- Pioglitazone: Useful in patients with type 2 diabetes and MASH; reduces liver inflammation
- Vitamin E: Evidence in non-diabetic MASH; limited to specific patient subgroups
Frequently Asked Questions
Does fatty liver cause pain?
Most patients with MASLD/fatty liver have no symptoms. Some experience mild right upper quadrant discomfort or fatigue. Significant pain is unusual in simple steatosis and may indicate complications such as hepatomegaly, MASH with inflammation, or an alternative diagnosis. Any significant abdominal pain warrants evaluation by a hepatologist.
Can I drink alcohol if I have fatty liver?
No. Alcohol worsens MASLD at any stage. Even moderate alcohol consumption in a patient with metabolic fatty liver increases the risk of progression to MASH and fibrosis. Complete abstinence is strongly recommended by all current guidelines.
How is MASLD diagnosed?
Liver ultrasound showing increased echogenicity is the standard initial test. FibroScan quantifies liver fat (CAP score) and fibrosis (liver stiffness measurement). Liver biopsy remains the gold standard for definitive diagnosis and fibrosis staging but is reserved for cases where non-invasive tests are inconclusive.
Author: Dr. Chetan Kalal — Hepatologist, Gleneagles Hospital Mumbai. MASLD and metabolic liver disease is one of Dr. Kalal’s key clinical areas. Learn more about MASLD management at Gleneagles Hospital Mumbai. ORCID: 0000-0002-5284-7890.
About the Author
Dr. Chetan Kalal — MBBS, MD (Internal Medicine), DM Hepatology (ILBS, New Delhi) — is the First DM Hepatologist of Maharashtra and Associate Director, Hepatology & Liver Transplant, at Gleneagles Hospital Mumbai. He has 26 peer-reviewed publications and serves on the APASL AARC Expert Panel. Fellow, National Academy of Medical Sciences (FNAMS). Learn more · Book appointment
