Introduction: 90% of fatty livers were "non-alcoholic".
When "fatty liver" is indicated in a medical checkup, most of the cases are "nonalcoholic fatty liver disease (NAFLD).
This was a condition in which fat accumulates in the liver due to lifestyle habits such as obesity and diabetes, even in the absence of viral hepatitis or heavy alcohol consumption.
However, in 2023, the American Association for the Study of the Liver (AASLD) and the International Association for the Study of the Liver (EASL) proposed a new disease concept, MASLD (Metabolic dysfunction-associated steatotic liver disease). The term "NAFLD" is now being internationally abolished (Lazarus et al., 2023).
What is the difference between NAFLD and MASLD?
| feature | NAFLD | MASLD (new name) |
| diagnostic criteria | Liver fat accumulation + low alcohol consumption | Liver fat accumulation + one or more metabolic abnormalities |
| Alcohol Standards | Male <30g/day, Female <20g/day | Not a clear standard, but the presence or absence of metabolic abnormalities is the main axis |
| Word Impressions | Emphasis on "not drinking." | Emphasis on "metabolic abnormalities." |
| problem | “Defined by the negative word ”non." | “Positive disease names that ”focus on causes |
The conventional definition of NAFLD was “a person who has a fatty liver even though he or she does not drink alcohol,” but there were issues regarding the boundaries of alcohol consumption and the reliability of the medical interview. In addition, numerous studies have shown that the essence of liver disease is "metabolic abnormalities," and this led to the birth of the disease concept of MASLD as a new framework.
Why is MASLD (formerly NAFLD) a problem?
Even in the stage when it was called non-alcoholic fatty liver, many people were caught off guard, thinking that they were fine because they had no particular symptoms. However, the following facts are known.
- About 701 TP3T or more fatty liver in obese and diabetic patients (Younossi et al., 2016)
- Fatty liver significantly increases the risk of liver cancer and cardiovascular disease (Targher et al., 2010)
- Approximately 301 TP3T of cirrhosis causes originate from non-alcoholic fatty liver (Chalasani et al., 2018)
In other words, “asymptomatic fatty liver” is an entry point for future life-threatening risks.
Diagnosis: What is "non-alcoholic fatty liver"?
To diagnose MASLD (formerly NAFLD), check the following
- Confirmation of hepatic fat accumulation (e.g., abdominal echo, MRI-PDFF, FibroScan CAP)
- Presence of metabolic abnormalities (one or more of the following)
- Obesity (BMI ≥25)
- Hypertension (systolic ≥130 mmHg or taking antihypertensive medication)
- Diabetes mellitus or HbA1c≥5.71 TP3T
- High TG (≥150 mg/dL) or low HDL (men <40 mg/dL, women <50 mg/dL)
- Obesity (BMI ≥25)
The presence or absence of alcohol intake is only informative, and metabolic abnormalities are the primary diagnostic basis.
Treatment strategy: Lifestyle + drug therapy as needed
✅ The basics are diet and exercise
A 5-101 TP3T reduction in body weight is strongly associated with liver fat loss (Vilar-Gomez et al., 2015), and carbohydrate restriction (<130 g/day) + high protein + aerobic exercise + muscle training is recommended.
▶ For more information, see → [Diet for fatty liver] / [Fatty liver Exercise].
✅ Free drug therapy (if desired)
- GLP-1 receptor agonists (e.g., Liberusas, Ozempic)
- Chilsepachido (Manjaro)
- High doses of vitamin E and probiotics (some papers suggest benefits)
and others are also accumulating evidence for both metabolic improvement and liver fat reduction (Newsome et al., 2021).
Summary: Fatty liver = MASLD is a "curable lifestyle disease
The disease formerly known as nonalcoholic fatty liver is now redefined as "MASLD". This is a disease that requires proactive measures as "fatty liver as a lifestyle-related disease with a background of metabolic abnormalities," rather than simply not drinking alcohol.
Ikejiri-Ohashi Sera Clinic provides consistent support from liver function check, echo, diet and exercise guidance, to free drug therapy.
If you are concerned, start with a "fatty liver check".
[References
- Lazarus, J.V. et al. (2023). The redefinition of fatty liver disease: an international consensus. Lancet Gastroenterol Hepatol, 8(3), 225-234.
- Younossi, Z. M. et al. (2016). Global epidemiology of NAFLD-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64(1), 73-84.
- Targher, G. et al. (2010). Nonalcoholic fatty liver disease and increased risk of cardiovascular disease. atherosclerosis, 211(1), 183-190.
- Chalasani, N. et al. (2018). The diagnosis and management of NAFLD: practice guidance from the AASLD. Hepatology, 67(1), 328-357.
- Vilar-Gomez, E. et al. (2015). Weight loss through lifestyle modification reduces fibrosis progression in patients with nonalcoholic steatohepatitis. Gastroenterology, 149(2), 367-378.
- Newsome, P.N. et al. (2021). A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis. New Engl J Med, 384(12), 1113-1124.
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