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The terms metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) were introduced to address several of the challenges and limitations associated with the former terminology. By transitioning away from stigmatizing and ambiguous terms, the nomenclature has adopted inclusionary language that emphasizes the underlying risk factors that drive disease progression and are accompanied by distinct diagnostic criteria. With SLD prevalence steadily increasing over the past few decades, affecting over 30% of the global population, accurate classification of the spectrum of conditions that fall under this overarching term is essential. Most importantly, the introduction of combined metabolic and alcohol-associated liver disease (MetALD) as a novel subclassification of SLD has shifted the diagnostic approach, raised awareness of disease prevalence, and paved the way for therapeutic management and multidisciplinary approaches to patient care. By recognizing the distinct clinical entity that is MetALD and the synergistic interplay between the cardiometabolic risk factors and alcohol use, clinicians are better equipped to effectively care for this patient population. In this review, we aim to discuss the catalysts for the SLD nomenclature changes, the dynamic nature of its subclasses, the natural history and disease burden, and the implications for clinical practice and research, with a particular focus on MetALD.<\/jats:p>","DOI":"10.1093\/gastro\/goag006","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T12:34:58Z","timestamp":1768048498000},"source":"Crossref","is-referenced-by-count":6,"title":["MetALD: decoding the evolution of steatotic liver disease nomenclature and implications for clinical practice and beyond"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5853-5564","authenticated-orcid":false,"given":"Farinaz","family":"Ghodrati","sequence":"first","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley B","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1889-3954","authenticated-orcid":false,"given":"Nadim","family":"Mahmud","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA,","place":["United States"]},{"name":"Department of Medicine, Corporal Michael J. Crescenz VA Medical Center , Philadelphia, PA,","place":["United States"]},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, PA,","place":["United States"]},{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026053010365019700_goag006-B1","volume-title":"StatPearls","author":"Sharma","year":"2023"},{"key":"2026053010365019700_goag006-B2","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1097\/HEP.0000000000000004","article-title":"The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic 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