FIGURE 5.

Steatotic liver disease (SLD) subclassification. This depicts the schema for SLD and its subcategories. SLD, diagnosed histologically or by imaging, has many potential aetiologies. Metabolic dysfunction associated steatotic liver disease (MASLD), defined as the presence of hepatic steatosis in conjunction with one cardiometabolic risk factor (CMRF) and no other discernible cause, ALD, and an overlap of the 2 (MetALD), comprises the most common causes of SLD. Persons with MASLD and steatohepatitis will be designated as metabolic dysfunction associated steatohepatitis (MASH). Within the MetALD group, there exists a continuum across which the contribution of MASLD and ALD will vary. To align with current literature, limits have been set accordingly for weekly and daily consumption, understanding that the impact of varying levels of alcohol intake varies between individuals. Other causes of SLD need to be considered separately, as is already done in clinical practice, given their distinct pathophysiology. Multiple aetiologies of steatosis can coexist. If there is uncertainty and the clinician strongly suspects metabolic dysfunction despite the absence of CMRF, this may be early MASLD and prompt additional testing (eg, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and oral glucose tolerance tests). Those with no identifiable cause (cryptogenic SLD) may be recategorised in the future pending developments in our understanding of disease pathophysiology. Finally, the ability to provide an affirmative diagnosis allows for the coexistence of other forms of liver disease with MASLD, for example, MASLD + autoimmune hepatitis or viral hepatitis. *Weekly intake 140–30 g female, 210–420 g male (average daily 20–50 g female, 30–60 g male). **eg, Lysosomal acid lipase deficiency (LALD), Wilson disease, hypobetalipoproteinemia, inborn errors of metabolism. ***eg, HCV, malnutrition, celiac disease, human immunodeficiency virus (HIV).