{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:26:56Z","timestamp":1760243216778,"version":"build-2065373602"},"reference-count":34,"publisher":"American Academy of Insurance Medicine","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Insur Med"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title\/>\n<jats:p>Liver steatosis is now the politically correct term for excessive fat in the liver (fatty liver). Its incidence and prevalence, in lockstep with diabetes and obesity, continue to climb to over 2 billion persons worldwide. It is the most common cause of chronic liver disease and the leading cause of liver-related morbidity and mortality. This treatise, resulting from a selection of PubMed literature of relevant steatosis studies since the nomenclature change in 2023, will include the change in the names for the steatotic liver entities, documenting the contribution of metabolic dysfunctions (obesity, diabetes, hypertension, and dyslipidemias) to the pathology of insulin resistance and alcohol in the evolution of these liver diseases. The various modalities for measuring the degree of fat, fibrosis, and cirrhotic scarring of the liver will be discussed, followed by a review of the mortality implications of the subcategories of liver steatosis, including intrahepatic cirrhosis and malignancy, extrahepatic malignancies, and cardiovascular disease. Finally, a review of treatments to address these entities will be briefly reviewed.<\/jats:p>","DOI":"10.17849\/insm-52-3-1-9.2","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:32:23Z","timestamp":1758501143000},"page":"128-136","source":"Crossref","is-referenced-by-count":0,"title":["Steatotic Liver Diseases (SLDs): A Review"],"prefix":"10.17849","volume":"52","author":[{"given":"Rodney C.","family":"Richie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7324","reference":[{"key":"i-52-3-128-ref01","series-title":"J Insur Med","first-page":"147","article-title":"Metabolic Muddle. MASLD and MASH on the Horizon","volume":"50","author":"Meagher,","year":"2023","unstructured":"Meagher, Timothy. Metabolic Muddle. MASLD and MASH on the Horizon. J Insur Med. 2023;50:147. https:\/\/doi.org\/10.17849\/insm-50-2-147-149.1"},{"key":"i-52-3-128-ref02","series-title":"Ann Hepatol","first-page":"101133","article-title":"A multi-society Delphi consensus statement on new fatty liver disease nomenclature","volume":"24","author":"Rinella","year":"2023","unstructured":"Rinella ME,\nLazarus JV,\nRatziu VK, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2023;24:101133. https:\/\/doi.org\/10.1097\/HEP.0000000000000520"},{"key":"i-52-3-128-ref03","series-title":"Lancet Gastroenterol Hepatol","first-page":"218","article-title":"Validation of the new nomenclature of steatotic liver disease in patients with a history of excessive alcohol intake: an analysis of data from a prospective cohort study","volume":"9","author":"Israelsen","year":"2024","unstructured":"Israelsen M,\nTorp N,\nJohansen S, et al. Validation of the new nomenclature of steatotic liver disease in patients with a history of excessive alcohol intake: an analysis of data from a prospective cohort study. Lancet Gastroenterol Hepatol. 2024;9:218. https:\/\/doi.org\/10.1016\/S2468-1253(23)00443-0"},{"issue":"1","key":"i-52-3-128-ref04","series-title":"J Hepatol","first-page":"191","article-title":"Alcohol consumption and metabolic syndrome: Cliinical and epidemiological impact on liver disease","volume":"78","author":"\u00c4berg","year":"2023","unstructured":"\u00c4berg F,\nByrne CD,\nPirola CJ,\nM\u00e4nnist\u00f6 V,\nSookoian S. Alcohol consumption and metabolic syndrome: Cliinical and epidemiological impact on liver disease. J Hepatol. 2023;78(1):191. https:\/\/doi.org\/10.1016\/j.jhep.2022.08.030. PMID: 36063967"},{"issue":"7","key":"i-52-3-128-ref05","series-title":"Gastroenterology","first-page":"1999","article-title":"MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease","volume":"158","author":"Eslam","year":"2020","unstructured":"Eslam M,\nSanyal AJ,\nGeorge J, International Consensus Panel. MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158(7):1999. https:\/\/doi.org\/10.1053\/j.gastro.2019.11.312. PMID: 32044314"},{"issue":"Suppl","key":"i-52-3-128-ref06","series-title":"Clin Mol Hepatol","first-page":"S32","article-title":"Global incidence and prevalence of nonalcoholic fatty liver disease","volume":"29","author":"Teng","year":"2023","unstructured":"Teng ML,\nNg CH,\nHuang DQ, et al. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29(Suppl):S32. https:\/\/doi.org\/10.3350\/cmh.2022.0365"},{"key":"i-52-3-128-ref07","series-title":"Lancet Gastroenterol Hepatol","article-title":"The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis","author":"Riaz","year":"2022","unstructured":"Riaz K,\nAzhari H,\nCharette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022. https:\/\/doi.org\/10.1016\/S2468-1253(22)00165-0"},{"key":"i-52-3-128-ref08","series-title":"J Hepatol","first-page":"1542","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Rinella","year":"2023","unstructured":"Rinella ME,\nLazarus JV,\nRatziu VK, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79:1542. https:\/\/doi.org\/10.1016\/j.jhep.2023.06.003. PMID: 37364790"},{"issue":"5","key":"i-52-3-128-ref09","series-title":"J Hepatol","first-page":"694","article-title":"Clinical profiles and mortality rates are similar for metabolic dysfunction-associated steatotic liver disease and non-alcoholic fatty liver disease","volume":"80","author":"Younossi","year":"2024","unstructured":"Younossi ZM,\nPaik JM,\nStephanova M,\nOng J,\nAlquahtani S,\nHenry L. Clinical profiles and mortality rates are similar for metabolic dysfunction-associated steatotic liver disease and non-alcoholic fatty liver disease. J Hepatol. 2024;80(5):694. https:\/\/doi.org\/10.1016\/j.jhep.2024.01.014. 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Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48(3):792. https:\/\/doi.org\/10.1002\/hep.22429. PMID: 18752331"},{"issue":"6","key":"i-52-3-128-ref12","series-title":"Hepatology","first-page":"1286","article-title":"Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values","volume":"37","author":"Mofrad","year":"2003","unstructured":"Mofrad P,\nContos MJ,\nHaque M, et al.. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37(6):1286. https:\/\/doi.org\/10.1053\/jhep.2003.50229. 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ALT levels, alcohol use, and metabolic risk factors have prognostic relevance for liver-related outcomes in the general population. JHEP Reports. 2024;6:101172. https:\/\/doi.org\/10.1016\/j.jhepr.2024.101172. PMID: 39430577"},{"issue":"3","key":"i-52-3-128-ref15","series-title":"Hepatology","first-page":"1082","article-title":"Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis","volume":"54","author":"Hernaez","year":"2011","unstructured":"Hernaez R,\nLazo M,\nBonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011;54(3):1082. https:\/\/doi.org\/10.1002\/hep.24452. 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PMID: 25039333"},{"issue":"7","key":"i-52-3-128-ref17","series-title":"J Gastroenterol Hepatol","first-page":"1788","article-title":"Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis","volume":"36","author":"Sharma","year":"2021","unstructured":"Sharma C,\nCococcia S,\nEllis N,\nParkes J,\nRosenberg W. Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis. J Gastroenterol Hepatol. 2021;36(7):1788. https:\/\/doi.org\/10.1111\/jgh.15482. PMID: 33668077"},{"key":"i-52-3-128-ref18","series-title":"Hepatol Commun","first-page":"e0075","article-title":"The steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population","volume":"7","author":"van Kleef","year":"2023","unstructured":"van Kleef LA,\nde Knegt RJ,\nAyada I,\nPan Q,\nBrouwer WP. The steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population. Hepatol Commun. 2023;7:e0075. https:\/\/doi.org\/10.1097\/HC9.0000000000000075. PMID: 37026734"},{"issue":"5","key":"i-52-3-128-ref19","series-title":"Gastroenterology","first-page":"1657","article-title":"Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease","volume":"161","author":"Kanwal","year":"2021","unstructured":"Kanwal F,\nShubrook JH,\nAdams LA,\nPfotenhauer K,\nWai-Sun Wong V,\nWright E, et al.. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657. https:\/\/doi.org\/10.1053\/j.gastro.2021.07.049. 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JAMA. 2024;331:1287. https:\/\/doi.org\/10.1001\/jama.2024.1447"},{"key":"i-52-3-128-ref22","series-title":"J Gastroenterol Hepatol","first-page":"2014","article-title":"Global epidemiology of lean non-alcoholic fatty liver disease: A systematic review and meta-analysis","volume":"35","author":"Lu","year":"2020","unstructured":"Lu F-B,\nZheng KI,\nRios RS,\nTargher G,\nByrne CD,\nZheng M-H. Global epidemiology of lean non-alcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2020;35:2014. https:\/\/doi.org\/10\/1111jgh.15156"},{"key":"i-52-3-128-ref23","series-title":"Lancet Gastroenterol Hepatol","first-page":"739","article-title":"Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis","volume":"5","author":"Ye","year":"2020","unstructured":"Ye Q,\nZou B,\nYeo YH,\nLi J, et al.. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5:739. https:\/\/doi.org\/10.1016\/S2468-1253(20)30077-7. PMID: 32413340"},{"key":"i-52-3-128-ref24","series-title":"Hepatology","first-page":"73","article-title":"Global epidemiology of nonalcoholic fattly liver disease\u2014Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","unstructured":"Younossi ZM,\nKoenig AB,\nAbdelatif D,\nFazel Y,\nHenry L,\nWymer M. Global epidemiology of nonalcoholic fattly liver disease\u2014Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73. https:\/\/doi.org\/10.1002\/hep.28431. PMID: 26707365"},{"key":"i-52-3-128-ref25","series-title":"Lancet Gastroenterol Hepatol","first-page":"851","article-title":"The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","unstructured":"Riazi K,\nAzhari H,\nCharette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7:851. https:\/\/doi.org\/10\/1016\/S2468-1253(22)00165-0. PMID: 3579021"},{"key":"i-52-3-128-ref26","series-title":"J Clin Gastroenterol","article-title":"Prevalence of MASLD, Met-ALD, and ALD and associated fibrosis among US adults: Insights from NHANES 2017 to 2023","author":"Paik","year":"2025","unstructured":"Paik JM,\nHobbs K,\nGupta A,\nAlkalbani RJ,\nReyes MA,\nYounossi ZM. Prevalence of MASLD, Met-ALD, and ALD and associated fibrosis among US adults: Insights from NHANES 2017 to 2023. J Clin Gastroenterol. 2025. Accessed online 7\/3\/2025. https:\/\/doi.org\/10.1097\/MCG.0000000000002202. PMID: 40423524"},{"key":"i-52-3-128-ref27","series-title":"Hepatobiliary Surg Nutr","first-page":"222","article-title":"Prevalence and longitudinal effects on mortality associated with spectrum of alcohol intake in steatotic liver disease: a United States population study","volume":"14","author":"Ong","year":"2025","unstructured":"Ong C,\nTang N,\nGunalan S, et al. Prevalence and longitudinal effects on mortality associated with spectrum of alcohol intake in steatotic liver disease: a United States population study. Hepatobiliary Surg Nutr. 2025;14:222. https:\/\/doi.org\/10.21037\/hbsn-24-51. PMID: 40342782"},{"key":"i-52-3-128-ref28","series-title":"Gut","first-page":"1375","article-title":"Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort","volume":"70","author":"Simon","year":"2021","unstructured":"Simon TG,\nRoelstraete Bjorn,\nKhalili H,\nHagstr\u00f6m H,\nLudvigsson JF. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021;70:1375. https:\/\/doi.org\/10.1136\/gutjnl-2020-322786. PMID: 33037056"},{"key":"i-52-3-128-ref29","series-title":"Gut","first-page":"170","article-title":"Mortality in biopsy-proven alcohol-related liver disease: a population-based nationwide cohort study of 3453 patients","volume":"70","author":"Hagstr\u00f6m","year":"2021","unstructured":"Hagstr\u00f6m H,\nThiele M,\nRoelstraete B,\nS\u00f6derling J,\nLudvigsson JF. Mortality in biopsy-proven alcohol-related liver disease: a population-based nationwide cohort study of 3453 patients. Gut. 2021;70:170. https:\/\/doi.org\/10.1136\/gutjnl-2019-320446. PMID: 32220902"},{"key":"i-52-3-128-ref30","series-title":"Lancet Gastroenterol Hepatol","first-page":"1028","article-title":"Cause-specific mortality in patients with alcohol-related liver disease in Denmark: a population-based study","volume":"8","author":"Kann","year":"2023","unstructured":"Kann AE,\nJepsen P,\nMadsen LG,\nWest J,\nAskgaard G. Cause-specific mortality in patients with alcohol-related liver disease in Denmark: a population-based study. Lancet Gastroenterol Hepatol. 2023;8:1028. https:\/\/doi.org\/10.1016\/S2468-1253(23)00192-9. PMID: 37660703"},{"key":"i-52-3-128-ref31","series-title":"J Hepatol","first-page":"643","article-title":"Cause-specific mortality in 13,099 patients with Metabolic Dysfunction-Associated Steatotic Liver Disease in Sweden","volume":"83","author":"Issa","year":"2025","unstructured":"Issa G,\nShang Y,\nStrandberg R, et al. Cause-specific mortality in 13,099 patients with Metabolic Dysfunction-Associated Steatotic Liver Disease in Sweden. J Hepatol. 2025;83:643\u2013651."},{"key":"i-52-3-128-ref32","series-title":"J Hepatol","first-page":"S0168-8278:02211-1","article-title":"Cause-specific mortality in patients with steatotic liver disease in the United States","author":"Ochoa-Allemant","year":"2025","unstructured":"Ochoa-Allemant P,\nHubbard RA,\nKaplan DE,\nSerper M. Cause-specific mortality in patients with steatotic liver disease in the United States. J Hepatol. 2025;S0168-8278:02211-1. https:\/\/doi.org\/10.1016\/j.jhep.2025.05.013. PMID: 40419118"},{"key":"i-52-3-128-ref33","series-title":"JHEP Reports","first-page":"101127","article-title":"Characteristics and long-term mortality of individuals with MASLD, MetALD, and ALD, and the utility of SAFE score","volume":"6","author":"Sripongpun","year":"2024","unstructured":"Sripongpun P,\nKoewdech A,\nUdompop P,\nKim WR. Characteristics and long-term mortality of individuals with MASLD, MetALD, and ALD, and the utility of SAFE score. JHEP Reports. 2024;6:101127."},{"key":"i-52-3-128-ref34","series-title":"Research Articles","article-title":"Clinical utility of phosphatidylethanol to detect underreported alcohol use and enhance steatotic liver disease subclassivication","author":"Tavaglione","year":"2025","unstructured":"Tavaglione F,\nDiaz LA,\nAjmera V,\nBettencourt R,\nRichards L,\nLoomba R. Clinical utility of phosphatidylethanol to detect underreported alcohol use and enhance steatotic liver disease subclassivication. 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