Non-alcoholic steatohepatitis (NASH)
Description
Nomenclature - renamed 2023, use the new terms
| Old | New |
|---|---|
| NAFLD | MASLD - metabolic dysfunction-associated steatotic liver disease |
| NAFL (simple steatosis) | MASL |
| NASH | MASH - metabolic dysfunction-associated steatohepatitis |
| - | MetALD - MASLD + alcohol 20-50 g/day (F) or 30-60 g/day (M) |
| - | ALD - above those thresholds |
- The definition is now positive, not exclusionary: hepatic steatosis + >=1 cardiometabolic criterion (BMI/waist, dysglycaemia, hypertension, hypertriglyceridaemia, low HDL)
- No longer requires excluding alcohol - steatotic liver disease from more than one cause is now nameable
MASL vs MASH - a histological distinction
- MASL - steatosis alone, no hepatocyte injury
- MASH - hepatocyte ballooning degeneration (the defining feature) + lobular inflammation +/- fibrosis
- Ballooning is what separates them, not the amount of fat
- Alcohol thresholds separating MASLD from ALD: 20 g/day women, 30 g/day men
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