Should experts rename ‘fatty liver disease’ to reduce stigma?

Individuals with nonalcoholic fatty liver disease (NAFLD) may face stigma from the disease or comorbidities, but the perceptions of shame differ across patients, healthcare providers, geographic locations, and subspecialties, reveals a study.

Two surveys about experiences or attitudes toward NAFLD and related diagnostic terms were created by members of the Global Nonalcoholic Steatohepatitis (NASH) Council: a 68-item patient and a 41-item provider survey.

A total of 1,976 patients with NAFLD across 23 countries (51 percent Middle East/North Africa [MENA], 19 percent Europe, 17 percent USA, 8 percent Southeast Asia, 5 percent South Asia) and 825 healthcare providers (67 percent gastroenterologists/hepatologists) across 25 countries (39 percent MENA, 28 percent Southeast Asia, 22 percent USA, 6 percent South Asia, 3 percent Europe) completed the survey.

Of the patients, nearly half (48 percent) revealed having NAFLD/NASH to family or friends. The most common term used was “fatty liver” (88 percent at least sometime), while “metabolic disease” or “MAFLD” were rarely used (never by >84 percent). In terms of perceptions of diagnostic terms, no substantial differences were seen between “NAFLD,” “fatty liver disease (FLD),” “NASH,” or “MAFLD.”

The most common response was being neither comfortable nor uncomfortable with either term (56‒71 percent), with slightly greater discomfort with “FLD” among US and South Asian patients (47‒52 percent uncomfortable).

Nearly one in four (26 percent) patients reported stigma associated with overweight/obesity, but less than one in 10 (8 percent) reported a history of stigmatization or discrimination due to NAFLD.

Among physicians, 38 percent and 34 percent thought the terms “fatty” and “nonalcoholic” were stigmatizing, more commonly in MENA (43 percent).

Approximately one in two (43 percent) providers (gastroenterologists/hepatologists 45 percent vs 37 percent other specialties; p=0.03) believed that changing the name to metabolic dysfunction-associated steatotic liver disease (MASLD) might reduce the stigma.

“Regarding the new nomenclature, the percentage of providers reporting ‘steatotic liver disease’ as stigmatizing was low (14 percent),” the researchers said.