Metabolic liver disease — what’s in a name?

Owing to the strong association of non-alcoholic fatty liver disease with obesity and cardiometabolic disease, in 2020 experts controversially proposed to rename this condition as ‘metabolic associated fatty liver disease’. Additional studies have elucidated new genetic and dietary modifiers of this disease. This knowledge is essential to improve diagnosis, risk-stratification and treatment. Key advances The largest genome-wide association study performed on liver biopsy samples to date confirmed a role for a variant in the PNPLA3 locus in the complete histological spectrum of non-alcoholic fatty liver disease and implicated PYGO1 , a gene involved in hepatocellular development, in this condition 3 . Preliminary data show that a machine learning algorithm efficiently quantified steatosis in population scale MRI data and helped define the role of genetic variants and environmental modifiers in hepatic steatosis, including a role for alcohol metabolism 5 . Fructose metabolism within the small intestine regulates the delivery of fructose to the liver and the distal colon, which affects hepatic lipogenesis and steatosis 8 – 10 .