Nonalcoholic Steatohepatitis
From NASH to MASH: a meaningful name change
What's in a name? A lot when it comes to engaging patients in care options
In 2023 the condition formerly known as non-alcoholic steatohepatitis, or NASH, was renamed to “metabolic dysfunction–associated steatohepatitis,” or MASH. A related change, the update of NAFLD (non-alcoholic fatty liver disease) to MASLD (metabolic dysfunction–associated steatotic liver disease) happened at the same time.
MASH, the more serious form of MASLD, is characterized by fat accumulation in the liver, inflammation of the liver, and “hepatocyte ballooning” (swelling of liver cells). When MASH is diagnosed, patients are counseled that they face high risk for even more serious illness developing. Without care and lifestyle changes, MASH can progress to fibrosis, cirrhosis, liver failure, or cancer. In fact, MASH is a top cause of liver transplantation.
The new names were encouraged and advocated for hundreds of physicians, public health experts, industry representatives, patient advocates who understood how individuals facing such liver problems felt stigmatized by the words ‘alcoholic’ and ‘fatty.’ These updates sought to reflect the biology of the illness, and in more clinically appropriate terms.
Removing stigma, improving diagnosis
“NASH” was first described in 1980 by Dr. Jurgen Ludwig and colleagues at the Mayo Clinic. The term 'non-alcoholic steatohepatitis' was devised to describe patients presenting with liver inflammation and damage that was similar to that typically seen in individuals with high intake/prolonged usage of alcohol. While NASH patients had not consumed significant amounts of alcohol, they still felt judged for their illness.
In addition to alleviating patient feelings of stigma and blame, the updated names more accurately define the illnesses in terms of their primary drivers: metabolic dysfunction (obesity and diabetes are two prime examples). Providers working in the field of hepatology (the study of the liver and associated organs) remain optimistic that as the name changes take further hold, earlier diagnosis may be an outcome. This is because primary care physicians may have an easier time recognizing the signs of the illness now that the name is more clear. Additionally, linking the diseases explicitly to cardiometabolic risk factors may encourage physicians to recommend screening in patients who are overweight, or managing type 2 diabetes or dyslipidemia.
In the last 45 years since the condition was formally named, there has been tremendous growth in the understanding of how the illness forms and progresses in the first place. Sugary drinks like soda are thought to be a key factor in the development of fat on the liver. Sodas are high in fructose and added sugars; these can lead to insulin resistance and liver inflammation. From here fat accumulation in the liver can accelerate and impair functioning.
Diet soda, which may be a better choice for weight loss than regular soda, unfortunately also appears to carry risk: heavy consumption of these has also been linked to MASLD and MASH. One theory points to artificial sweetener as potentially disrupting heathy gut microbiota (these are the bacteria and other micro-organisms that help aid digestion and nutrient absorption).
Given the increasing prevalence of MASH worldwide, and the potential dangerous complications of it, there has been increased research efforts to find treatment options. In fact, in 2024, Rezdiffra (resmetirom) became the first approved treatment for MASH with fibrosis.
Today there continue to be many new therapies in development and going through clinical trials – and these include GLP-1 therapies that have shown much promise in diabetes and obesity. There is also significant effort in advancing imaging diagnostics and biomarker discovery to reduce the reliance on invasive biopsies during the diagnosis process.
The transition from NASH to MASH is more than a name change. It reflects a new way of thinking about a serious illness that continues to impact more and more people. With more appropriate names based on what the illness actually is, and how it arises, the stage has been set for better awareness, patient dialogue, and research innovation.
MASH, the more serious form of MASLD, is characterized by fat accumulation in the liver, inflammation of the liver, and “hepatocyte ballooning” (swelling of liver cells). When MASH is diagnosed, patients are counseled that they face high risk for even more serious illness developing. Without care and lifestyle changes, MASH can progress to fibrosis, cirrhosis, liver failure, or cancer. In fact, MASH is a top cause of liver transplantation.
The new names were encouraged and advocated for hundreds of physicians, public health experts, industry representatives, patient advocates who understood how individuals facing such liver problems felt stigmatized by the words ‘alcoholic’ and ‘fatty.’ These updates sought to reflect the biology of the illness, and in more clinically appropriate terms.
Removing stigma, improving diagnosis
“NASH” was first described in 1980 by Dr. Jurgen Ludwig and colleagues at the Mayo Clinic. The term 'non-alcoholic steatohepatitis' was devised to describe patients presenting with liver inflammation and damage that was similar to that typically seen in individuals with high intake/prolonged usage of alcohol. While NASH patients had not consumed significant amounts of alcohol, they still felt judged for their illness.
In addition to alleviating patient feelings of stigma and blame, the updated names more accurately define the illnesses in terms of their primary drivers: metabolic dysfunction (obesity and diabetes are two prime examples). Providers working in the field of hepatology (the study of the liver and associated organs) remain optimistic that as the name changes take further hold, earlier diagnosis may be an outcome. This is because primary care physicians may have an easier time recognizing the signs of the illness now that the name is more clear. Additionally, linking the diseases explicitly to cardiometabolic risk factors may encourage physicians to recommend screening in patients who are overweight, or managing type 2 diabetes or dyslipidemia.
In the last 45 years since the condition was formally named, there has been tremendous growth in the understanding of how the illness forms and progresses in the first place. Sugary drinks like soda are thought to be a key factor in the development of fat on the liver. Sodas are high in fructose and added sugars; these can lead to insulin resistance and liver inflammation. From here fat accumulation in the liver can accelerate and impair functioning.
Diet soda, which may be a better choice for weight loss than regular soda, unfortunately also appears to carry risk: heavy consumption of these has also been linked to MASLD and MASH. One theory points to artificial sweetener as potentially disrupting heathy gut microbiota (these are the bacteria and other micro-organisms that help aid digestion and nutrient absorption).
Given the increasing prevalence of MASH worldwide, and the potential dangerous complications of it, there has been increased research efforts to find treatment options. In fact, in 2024, Rezdiffra (resmetirom) became the first approved treatment for MASH with fibrosis.
Today there continue to be many new therapies in development and going through clinical trials – and these include GLP-1 therapies that have shown much promise in diabetes and obesity. There is also significant effort in advancing imaging diagnostics and biomarker discovery to reduce the reliance on invasive biopsies during the diagnosis process.
The transition from NASH to MASH is more than a name change. It reflects a new way of thinking about a serious illness that continues to impact more and more people. With more appropriate names based on what the illness actually is, and how it arises, the stage has been set for better awareness, patient dialogue, and research innovation.
Published Date September 09, 2025
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