Key points
- MASLD = hepatic steatosis (imaging, biopsy or CAP) + ≥1 of 5 cardiometabolic criteria.
- MASH is the inflammatory form. It is still a histological diagnosis.
- MetALD = MASLD plus moderate alcohol intake (140–350 g/week women, 210–420 g/week men).
- Always look for other causes before labelling MASLD.
For the evidence, graded recommendations, a case and self-test questions, read Module 1: Assessing liver fibrosis in MASLD.
1The five cardiometabolic criteria (adults)
One is enough. Each criterion also counts if the patient is on treatment for it.
| Criterion | Threshold |
|---|---|
| Weight | BMI ≥25 kg/m² (≥23 in Asian people), or waist >94 cm men / >80 cm women (>90 cm men in South Asian and Chinese people) |
| Glucose | Fasting glucose ≥5.6 mmol/L (100 mg/dL), 2-h glucose ≥7.8 mmol/L (140 mg/dL), HbA1c ≥5.7%, or type 2 diabetes |
| Blood pressure | ≥130/85 mmHg |
| Triglycerides | ≥1.70 mmol/L (150 mg/dL) |
| HDL cholesterol | ≤1.0 mmol/L (40 mg/dL) men, ≤1.3 mmol/L (50 mg/dL) women |
2The steatotic liver disease family
| Term | Meaning |
|---|---|
| SLD | Steatotic liver disease: the umbrella term for any fatty liver |
| MASLD | Steatosis + ≥1 cardiometabolic criterion, little or no alcohol |
| MASH | MASLD with steatohepatitis (inflammation and ballooning) on biopsy |
| MetALD | MASLD + 140–350 g/week (women) or 210–420 g/week (men) alcohol |
| ALD | Alcohol-related liver disease: above those amounts |
| Specific causes | Drug-induced, monogenic, other (e.g. Wilson disease, HCV genotype 3) |
| Cryptogenic SLD | Steatosis with no cardiometabolic criterion and no other cause |
3Rule out other causes
A standard first work-up for raised liver tests or steatosis:
- Alcohol history in grams per week; AUDIT-C helps.
- HBsAg and anti-HCV.
- Medicines: amiodarone, methotrexate, tamoxifen, corticosteroids, valproate, some antiretrovirals.
- Ferritin and transferrin saturation. A high ferritin is common in MASLD; check saturation before thinking of haemochromatosis.
- If ALT is high or the picture is unusual: autoimmune markers and IgG, ceruloplasmin (under 40 years), alpha-1 antitrypsin, coeliac serology, TSH.
4When is a biopsy needed?
Rarely, now. Consider it when non-invasive tests disagree, when another liver disease is suspected, or for a trial. Biopsy is the only way to confirm MASH and grade activity.
Related topics
References
- Rinella ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023;79:1542–56. doi:10.1016/j.jhep.2023.06.003
- EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD. J Hepatol 2024;81:492–542. doi:10.1016/j.jhep.2024.04.031
- Rinella ME, et al. AASLD Practice Guidance on the clinical assessment and management of NAFLD. Hepatology 2023;77:1797–835. doi:10.1097/HEP.0000000000000323
- Abaalkhail F, et al. MASLD management in Saudi Arabia: a modified Delphi-based adaptation of international standards. Saudi J Gastroenterol 2026;32(2):104–20. doi:10.4103/sjg.sjg_199_25
How to cite this page
Desoky M. Definitions and diagnosis of MASLD. Metabolic Liver Academy quick reference, version 1.0. Updated 2026-10-03. Available from: https://drmahmouddesoky.github.io/metabolic-liver-academy/ref/definitions.html
A summary of published guidelines for healthcare professionals. It does not replace clinical judgement, the full guidelines or local drug labels. Disclaimer.