Advocating for the implementation of the new nomenclature for steatotic liver disease: A call to action for the national associations
Authors: Francesco Paolo Russo, Sven M. Francque, Debbie L. Shawcross, Aleksander A. Krag
Journal: Journal of Hepatology (2023)

In June 2023, during the Liver Congress, the annual meeting of the European Association for the Study of the Liver (EASL), the leadership of a broad international coalition, led by La Asociación Latinoamericana para el Estudio del Hígado (ALEH), the American Association for the Study of Liver Diseases (AASLD), and EASL, as well as the co-chairs of the Non Alcoholic Fatty Liver Disease (NAFLD) Nomenclature Initiative announced that steatotic liver disease (SLD) was chosen as an overarching term to encompass the various aetiologies of hepatic steatosis.1Rinella M.E. Lazarus J.V. Ratziu V. et al.A multisociety Delphi consensus statement on new fatty liver disease nomenclature.J Hepatol. 2023 Jun 24; (S0168-8278(23)00418-X. Epub ahead of print. PMID: 37364790))https://doi.org/10.1016/j.jhep.2023.06.003Abstract Full Text Full Text PDF Scopus (409) Google Scholar, 2Rinella M.E. Lazarus J.V. Ratziu V. et al.A multisociety Delphi consensus statement on new fatty liver disease nomenclature.Hepatology. 2023 Dec 1; 78 (Epub 2023 Jun 24. PMID: 37363821; PMCID: PMC10653297): 1966-1986https://doi.org/10.1097/HEP.0000000000000520Crossref PubMed Scopus (300) Google Scholar, 3Rinella M.E. Lazarus J.V. Ratziu V. et al.A multisociety Delphi consensus statement on new fatty liver disease nomenclature.Ann Hepatol. 2023 Jun 24; 29 (Epub ahead of print. PMID: 37364816)101133https://doi.org/10.1016/j.aohep.2023.101133Crossref PubMed Scopus (101) Google Scholar The hundreds of millions of individuals living with or at risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) have been neglected for too long, with severe consequences; the disease is emerging as a leading cause of liver-related morbidity and mortality, liver cancer, and liver transplantation in many parts of the world, with a huge impact on quality of life as well as a socioeconomic consequences.4Krag A. Buti M. Lazarus J.V. et al.Uniting to defeat steatotic liver disease: a global mission to promote healthy livers and healthy lives.J Hepatol. 2023 Nov; 79 (Epub 2023 Aug 25. PMID: 37634993): 1076-1078https://doi.org/10.1016/j.jhep.2023.07.029Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Moreover, the impact of alcohol, another main driver of SLD, is also a major concern in many countries and the interaction or synergism between the two main drivers of SLD is poorly studied and understood. In this context, it has been argued that the low awareness may be partially due to disease stigma and/or the terminology used to describe this liver disease, both of which could vary and/or be perceived differently across languages and cultures. However, unlike other liver diseases, such as hepatitis C infection, where the presence of stigma has been well documented and shown to drive discrimination, reduction in healthcare seeking behaviour, as well as allocation of healthcare resources, evidence supporting the presence and impact of stigma in NAFLD is less well studied.5Younossi Z.M. AlQahtani S.A. Alswat K. et al.Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease.J Hepatol. 2023 Nov 18; (S0168-8278(23)05279-0. Epub ahead of print. PMID: 37984709)https://doi.org/10.1016/j.jhep.2023.11.004Abstract Full Text Full Text PDF Scopus (12) Google Scholar The new nomenclature has been supported and endorsed by more than 100 societies and organizations worldwide, with more than 40 from Europe. This modification in terminology and definitions is intended to improve the management of people with SLD of different and often combined aetiology and will foster the necessary research that should enhance our understanding of the condition, ultimately yielding advantages for both patients and practitioners. The adoption of the SLD designation marks a stride in diminishing stigma and elevating comprehension of SLD among both clinicians and patients.6Semmler G. Wernly B. Datz C. What's in a name? New nomenclature for steatotic liver disease - to be or not to be?.J Hepatol. 2023 Aug 9; (S0168-8278(23)05048-1. Epub ahead of print. PMID: 37567365)https://doi.org/10.1016/j.jhep.2023.07.035Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar In the months following the announcement, the leading liver societies have undertaken several steps to facilitate the adoption of the new nomenclature by the global liver community. In order to facilitate a seamless and effective shift to the updated nomenclature, EASL is dedicated to implementing a thorough and cooperative phased awareness plan. Specifically, EASL has made significant contributions through various channels: Webpage: EASL has actively utilized its official webpage as a platform to disseminate information and updates regarding the evolving nomenclature. This webpage serves as a central hub for professionals seeking the latest insights in the field. SLD Summit: The SLD Summit organized by EASL has played a pivotal role in fostering discussions and collaborations related to the nomenclature. This summit served as a key event bringing together experts and stakeholders in the global hepatology community. Journal of Hepatology and JHEP Reports: EASL's influential scientific journals have provided comprehensive space for research papers and opinion letters on nomenclature, contributing to the implementation of the new terminology and concepts. EASL Studio episodes: three studio episodes have been dedicated to the issue, covering the launch of the new nomenclature, JHEP-related studies, and the latest episode on the new nomenclature and alcohol. These episodes have been disseminated to a broad audience, with each episode reaching approximately 1,000 viewers from around 50 countries. During the first week of November 2023, EASL asked the European national associations if they have taken steps to implement the new nomenclature. Responses were received from Belgium, Georgia, Germany, Italy, Portugal, Sweden, the UK and Ukraine and the actions adopted are summarized in Table 1.Table 1Steps taken by European national associations to implement new nomenclature.Actions adoptedBelgium1.The nomenclature was discussed by the Belgian experts in the fields.2.Expression of some concerns on the inclusion of patients with alcohol-related liver disease in the definition of MetALD.3.The steering committee nevertheless sees a great benefit in the change of the NAFLD nomenclature to an inclusive terminology and wishes to provide its endorsement.Denmark1.Commissioned an update of the national guidelines to embrace and implement SLDGeorgia1.Disseminate the consensus document amongst their members.2.Translate and adapt the terms in Georgian.3.Publish them on the society's webpage (hepatology.ge).4.Share them across all Georgian medical societies.Germany1.Disseminate the consensus document amongst their members.2.Translation of the nomenclature summary into German.Italy1.Adopt the new nomenclature in the programmes of all scheduled national meetings.2.Encourage the members to adopt the new nomenclature in all abstracts submitted to the annual meeting.Portugal1.The communication materials from the national society have been updated to use the new nomenclature.2.The new nomenclature will be used in the national congress programme in 2024.3.Encouraging authors of abstracts submitted to the national meeting and in articles published in their journals to use the new terminology.Sweden1.Update their previous NAFLD guidelines.2.Recommend adoption of the new nomenclature in the national society journal.3.Suggest persons lecturing in the field to switch to using the term MASLD.UK1.Endorse and adopt the new nomenclature.Ukraine1.Information materials on the subject are widely posted on websites (liver.org.ua).2.Highlight in the reports of leading gastroenterologists.3.During the "XV Ukrainian Gastroenterological Week", all the associations made decisions on the implementation of the new nomenclature into clinical practice. Open table in a new tab We extend our sincere gratitude to the forward-thinking national associations that have embraced and implemented the new nomenclature for SLD, demonstrating their commitment to advancing medical precision and collaborative efforts for the benefit of patients and the broader healthcare community. However, to fully realize the objectives of the new nomenclature in advancing our understanding of SLD, it is imperative that all national associations wholeheartedly adopt and diligently implement this standardized terminology, ensuring a harmonized and comprehensive approach across borders for the betterment of liver health worldwide. The proposed shift is not merely a semantic adjustment, but a strategic measure aimed at enhancing the precision and clarity of our understanding of this complex condition. By adopting a unified terminology, we pave the way for a more coherent and streamlined approach to research, diagnosis, and treatment. The new nomenclature, meticulously designed to encapsulate the diverse facets of SLD, ensures a more nuanced, inclusive and comprehensive representation of the condition. This transition holds the promise of facilitating a shared language among healthcare professionals, researchers, and other stakeholders, fostering a collaborative environment that is conducive to advances in knowledge and patient care. Furthermore, a standardised nomenclature aligns with global efforts to establish consistent practices, promoting interoperability in a rapidly evolving medical landscape. Finally, the new SLD nomenclature should not be seen as static. If universally adopted, evolving knowledge will help identify the areas where the new nomenclature really delivers on improving research and clinical management, and areas where further refinement is needed and can justify a future revision, as medical science is ever evolving. With a shared global commitment to advancing medical understanding and improving patient outcomes, there is a hopeful anticipation that all national associations will unite in adopting the new nomenclature for SLD, working collaboratively to implement it at a national level and collectively ushering in a new era of enhanced clarity and of cooperation to effectively promote liver health. The authors received no financial support to produce this manuscript. The authors declare no conflict of interest pertaining to this article. Please refer to the accompanying ICMJE disclosure forms for further details. The four authors contributed equally to the editorial and agreed on the messages conveyed. The following are the supplementary data to this article: Download .pdf (.5 MB) Help with pdf files Multimedia component 1