NAFLD is Now Called MASLD
In 2023, a multi-society consensus (EASL, AASLD, APASL) officially renamed Non-Alcoholic Fatty Liver Disease (NAFLD) to MASLD — Metabolic dysfunction-Associated Steatotic Liver Disease. NASH is now called MASH (Metabolic dysfunction-Associated Steatohepatitis). The biology is identical; the new name removes the stigmatising label, emphasises metabolic syndrome as the driver, and creates a cleaner taxonomy.
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. Rising obesity, type 2 diabetes, and sedentary lifestyles are driving a parallel epidemic. Importantly, lean MASLD — fatty liver in non-obese individuals — is especially prevalent in the Indian subcontinent.
When Does Fatty Liver Become Dangerous?
- Simple steatosis (F0–F1): Usually benign; reversible with lifestyle change
- MASH with early fibrosis (F1–F2): Elevated risk; close monitoring and lifestyle intervention
- MASH with advanced fibrosis (F3–F4/cirrhosis): High risk of liver failure, portal hypertension, and hepatocellular carcinoma. Annual FibroScan recommended.
Can Fatty Liver Be Reversed?
Lifestyle modification (first-line): 7–10% body weight reduction resolves MASH in most patients. Mediterranean diet, avoid sugar-sweetened beverages, 150–300 minutes of moderate exercise per week, complete alcohol abstinence.
Pharmacological (2024–2025):
- Semaglutide (GLP-1 agonist): Significant evidence for weight loss and MASH resolution
- Resmetirom: FDA-approved March 2024 — first approved drug for MASH with fibrosis (F2–F3)
- Pioglitazone: Useful in type 2 diabetes with MASH
FAQs
Does fatty liver cause pain?
Most MASLD patients have no symptoms. Some have mild right upper quadrant discomfort or fatigue. Significant pain warrants hepatologist evaluation.
Can I drink alcohol with fatty liver?
No. Alcohol worsens MASLD at any stage and increases fibrosis risk. Complete abstinence is recommended by all current guidelines.
How is MASLD diagnosed?
Liver ultrasound is the initial test. FibroScan quantifies fat (CAP score) and fibrosis (liver stiffness). Biopsy remains gold standard for definitive staging when non-invasive tests are inconclusive.
Author: Dr. Chetan Kalal, Hepatologist, Gleneagles Hospital Mumbai. MASLD service page. 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
