If you are still writing NAFLD on your discharge summaries, referral letters, or patient prescriptions, it is time to update. The global hepatology community officially replaced Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) with new nomenclature in 2023 — but many Indian doctors are still using the old terms. This is not just a branding change. The new terminology reflects a better understanding of the disease mechanism and has real implications for how you diagnose, counsel, and treat patients. What Changed and Why The old term "non-alcoholic" defined the disease by what it is not (not caused by alcohol). This was stigmatising, confusing for patients, and mechanistically misleading. A 2023 multi-society consensus replaced it with: MASLD: Metabolic Dysfunction-Associated Steatotic Liver Disease — the new umbrella term replacing NAFLD MASH: Metabolic Dysfunction-Associated Steatohepatitis — replaces NASH (steatosis + inflammation + hepatocyte injury) SLD: Steatotic Liver Disease — the overarching term covering all causes of fatty liver MetALD: A new subcategory for patients with metabolic dysfunction who also drink moderate to significant amounts of alcohol The key conceptual shift: the disease is now defined by the presence of cardiometabolic risk factors, not by the absence of alcohol use. Diagnostic Criteria for MASLD A patient has MASLD if they have hepatic steatosis (by imaging, blood biomarker, or histology) PLUS at least one of the following cardiometabolic risk factors: BMI ≥25 kg/m² (or ≥23 kg/m² in South/East Asians) Fasting glucose ≥5.6 mmol/L (100 mg/dL) or diagnosed T2DM Fasting triglycerides >1.7 mmol/L (150 mg/dL) HDL cholesterol <1.0 mmol/L (men) or <1.3 mmol/L (women) Blood pressure ≥130/85 mmHg or on antihypertensive treatment MASLD/MASH: Update Your Terminology and Workflow Indian clinicians should now replace NAFLD and NASH with the updated 2023 global nomenclature and adjust diagnostic and management workflows accordingly. 1. Use the New Terms in All Clinical Documents Update discharge summaries, referral letters, prescriptions, and EMR templates: NAFLD → MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) Stop Writing NAFLD/NASH: Update to MASLD/MASH in Your Letters and EMR From 2023, the global hepatology community has replaced NAFLD and NASH with a new, mechanistic, less-stigmatising nomenclature. If your discharge summaries, referral letters, or EMR still say NAFLD or NASH, it is time to update. New Nomenclature MASLD – Metabolic Dysfunction-Associated Steatotic Liver Disease Stop Writing NAFLD/NASH: Update to MASLD/MASH in All Clinical Documents From 2023, the global hepatology community has replaced NAFLD and NASH with new, mechanistically accurate terminology. Indian clinicians should now use these terms in discharge summaries, referral letters, OPD notes, and patient counselling. New Nomenclature SLD – Steatotic Liver Disease Overarching term for all fatty liver disorders (irrespective of cause). MASLD – Metabolic Dysfunction-Associated Steatotic Liver Disease Replaces NAFLD. Steatosis plus at least one cardiometabolic risk factor. MASH – Metabolic Dysfunction-Associated Steatohepatitis Replaces NASH. Histological steatohepatitis in the setting of MASLD. MetALD – Metabolic dysfunction-Associated Alcohol-Related Liver Disease New subcategory: MASLD plus significant alcohol intake. Key conceptual shift: disease is defined by presence of metabolic dysfunction, not by absence of alcohol. Diagnostic Criteria for MASLD Step 1 – Confirm hepatic steatosis by any of: Ultrasound (bright liver, increased echogenicity) Controlled attenuation parameter (FibroScan) CT/MRI evidence of steatosis Histology Step 2 – At least ONE of the following cardiometabolic risk factors: BMI ≥25 kg/m², or ≥23 kg/m² in South/East Asians (use ≥23 for Indian patients) Fasting glucose ≥5.6 mmol/L (100 mg/dL) or diagnosed type 2 diabetes Fasting triglycerides >1.7 mmol/L (150 mg/dL) Management in Primary Care No MASLD/MASH-specific drug is approved in India as of 2026. Resmetirom has FDA approval in the US but is not yet available locally. Management centres on lifestyle and cardiometabolic optimisation. Weight Loss 7–10% total body weight loss → significant reduction in liver fat ≥10% weight loss → can improve MASH histology and regress fibrosis in some patients Even 3–5% loss reduces liver fat — encourage any sustained loss GLP-1 Agonists and SGLT-2 Inhibitors GLP-1 agonists (semaglutide, tirzepatide): Strong evidence for weight loss and liver fat reduction in T2DM/obesity. Use when otherwise indicated — dual benefit for glucose, weight and liver SGLT-2 inhibitors (empagliflozin, dapagliflozin): Reduce liver fat as a secondary benefit in T2DM patients Statins: NOT Contraindicated Cardiovascular disease is the leading cause of death in MASLD — statins are beneficial and should not be withheld Mildly elevated transaminases from MASLD are NOT a reason to stop statins Alcohol and MetALD Advise minimisation or complete abstinence from alcohol in all MASLD patients If patient has steatosis + metabolic risk + significant alcohol → classify as MetALD and address both axes (metabolic optimisation + alcohol reduction counselling/referral) Dietary Advice for Indian Patients Explicitly avoid: Sugar-sweetened beverages, packaged juices, fructose-rich foods, ultra-processed snacks, excess maida and white rice Encourage: High-fibre diet (millets, whole grains, dals, vegetables), adequate protein, healthy fats in moderation How to Talk to Patients About MASLD Avoid the word 'non-alcoholic' — it is confusing and stigmatising. Use plain, non-judgmental language: "Your liver has fat deposits linked to your blood sugar, blood pressure, and weight. The good news is that if we improve your metabolic health — especially your weight — your liver can improve too." Quick Reference: Old vs New Terminology | Old Term | New Term | |---|---| | NAFLD | MASLD | | NASH | MASH | | Simple steatosis (no metabolic risk) | SLD without metabolic risk | | NAFLD + significant alcohol | MetALD | How Doctrust Supports Your MASLD Practice Managing MASLD properly requires longitudinal tracking of FIB-4 scores, metabolic labs, weight trends, and timely specialist referrals. Doctrust gives Indian clinics the digital infrastructure to do this systematically: automated FIB-4 calculation, serial lab tracking, annual review reminders, and instant referral documentation — all in one EMR. Visit www.doctrust.in to see all features and book a demo today to digitise your clinic in one click.