Much more than a name change: Impact of the new steatotic liver disease nomenclature on clinical algorithms and disease classification in U.S. adults and adolescents

Background and Aims: The newly proposed nomenclature for steatotic liver diseases (SLD) aims to reduce the stigma associated with “non-alcoholic fatty liver disease” (NAFLD), increase awareness, and provide a framework for delineating pathogenic pathways. Approach and Results: We projected the new nomenclature’s diagnostic scheme onto National Health and Nutrition Examination Survey (NHANES) data and determined SLD prevalence, fibrosis risk factors, subtypes, and consistency with previous classifications. Steatosis grade and fibrosis stage were estimated from vibration controlled transient elastography (VCTE). At a threshold of 240 dB/m, 62.1% [95% confidence interval (CI), 59.8-64.3%] of adults (≥ 20 years) and 30.5% (95% CI, 27.1-34.0%) of adolescents (12-19 years) had SLD. By American Gastroenterological Association criteria, 19.3 million (95% CI, 15.8-22.8) adults with SLD qualify for hepatology referral. Over 98% of adults but only 85% of adolescents with NAFLD met criteria for definite MASLD. Significant fibrosis (≥ 8.6 kPa) occurred in 13.5 million (95% CI, 10.9-16.2) adults with MASLD; risk factors varied by race and ethnicity. Significant fibrosis occurred in over 1.5 million adults without any identified LD and was associated with lead (Pb) exposure, odds ratio = 3.89 (95% CI, 2.00-7.56). Conclusions: The overarching term, SLD, changes the diagnostic algorithm and creates an umbrella classification that highlights the extraordinary prevalence of liver steatosis. The more precise nomenclature establishes a valuable patient-centric platform for research and clinical care, clarifying risk groups and risk factors, including adolescents with NAFLD but without definite MASLD and adults without SLD in whom toxic exposures may increase fibrosis risk. ### Competing Interest Statement Mount Sinai receives support for Dr. Branch research. Dr. Jaime Chu has done ad hoc consulting for Albireo Pharma in the last one year. Dr. Meena Bansal has done consulting/Ad boards in Kinetix, Madrigal, Pfizer, Theratechnologies, Fibronostics, and NOVO Nordisk; and Mount Sinai receives support for Dr. Bansal research. ### Funding Statement Prevent Cancer Foundation (PCF 604934), U01OH011489, U01OH012263, and U01 OH012622 from the National Institute for Occupational Safety and Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We analyzed de-identified public available National Health and Nutrition Examination Survey(NHANES) data. IRB review was waived for analysis of de-identified NHANES data. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at