Steps on the way to a new nomenclature of liver diseases

Abstract

The term «steatotic liver disease (SLD)» is proposed to cover all patients with hepatosteatosis. Patients with SLD with one or more of the five cardiometabolic risk factors (CMRF) are further divided into «metabolic dysfunction‑associated steatotic liver disease» (MASLD) or «metabolic‑alcohol‑associated liver disease» (MetALD)/other combination of etiologies. СMRF includes: 1) body mass index ≥25 kg/m2 (≥23 kg/m2 for people of Asian nationality) or waist circumference >94 cm for men and >80 cm for women or taking into account ethnicity; 2) fasting serum glucose level ≥5.6 mmol/l (≥100 mg/dL) or glucose level 2 hours after exercise ≥7.8 mmol/l (≥140 mg/dL) or glycated hemoglobin ≥5.7% (≥39 mmol/L) or type 2 diabetes mellitus, or type 2 diabetes treatment; 3) blood pressure ≥130/85 mm Hg or antihypertensive treatment; 4) plasma triglycerides ≥1.70 mmol/l (≥150 mg/dL) or lipid‑lowering therapy; and 5) plasma high‑density lipoprotein cholesterol ≤1.0 mmol/L (Ј 40 mg/dL) for men and ≤1.3 mmol/L (Ј 50 mg/dL) for women or the patient’s receipt of lipid‑lowering treatment. Patients with SLD and at least one of the СMRF belong to the category of MASLD, if they have no other causes of steatosis. Patients in the new category of MetALD have characteristics corresponding to MASLD and consume alcohol in the amount of 20 to 50 g/day for women and 30 to 60 g/day for men. In the absence of any СMRF, cryptogenic SLD or SLD with another specific etiology (alcoholic liver disease, drug‑induced liver damage, and monogenetic diseases) are distinguished. In the new nomenclature, the stages of steatosis and liver fibrosis have not been changed.