The MASLD criteria overlook a number of adolescent patients with severe steatosis

We read with a great interest the consensus statement on the proposed new fatty liver disease nomenclature to replace non-alcohol fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD) and diagnostic criteria for diagnosing MASLD in children and adolescents [1] Rinella M.E. Lazarus J.V. Ratziu V. et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023; 79: 1542-1556 Abstract Full Text Full Text PDF PubMed Scopus (326) Google Scholar . These criteria are similar (although not identical) to the diagnostic criteria of the metabolic dysfunction–associated fatty liver disease (MAFLD), which was the first definition to provide a set of positive diagnostic criteria that acknowledge that fatty liver is a continuum across the lifespan 2 Eslam M. Newsome P.N. Sarin S.K. et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. Journal of hepatology. 2020; 73: 202-209 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 3 Eslam M. Sanyal A.J. George J. et al. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020; 158: 1999-2014. e1991 Abstract Full Text Full Text PDF PubMed Google Scholar , 4 Eslam M. Alkhouri N. Vajro P. et al. Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus statement. The Lancet Gastroenterology & Hepatology. 2021; 6: 864-873 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar . Others have suggested that before this new proposal is endorsed, a systematic, evidence-based approach should be performed wherein the change in definition should ultimately lead to the advancement of our characterisation of the disease [5] Fouad Y. Elwakil R. Elsahhar M. et al. The NAFLD‐MAFLD debate: eminence vs evidence. Liver International. 2021; 41: 255-260 Crossref PubMed Scopus (0) Google Scholar . A multisociety Delphi consensus statement on new fatty liver disease nomenclatureJournal of HepatologyVol. 79Issue 6PreviewThe principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favour of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. Full-Text PDF Open Access