Words are powerful and the language we use can have different meanings, whether intended or not. A narrative is set by the choice of words used. Paying careful attention to the language used in our articles (in various ways) is a big part of what we do as a journal, and we strive to thoroughly and sensitively edit all of our content. As language also continually evolves, so does the journal’s approach to language use.

“the language we use can have different meanings”

At Nature Reviews Gastroenterology & Hepatology, our editors, art editors and production staff all work together with our authors to produce authoritative, accessible and high-quality articles. To ensure these high standards, we provide support to our authors throughout the editorial process, a key component of which is the detailed editing stage. Alongside examining structure, flow, clarity and scientific accuracy, this step also examines the language used. Some of these changes can be subtle. For example, the journal has long used person-first language; that is, we always refer to a ‘patient/person with…’ a particular condition rather than defining them by their disease (such as ‘IBD patient’). Other interventions can have a major influence on the tone of the piece.

Within the Nature Reviews department, alongside access to wider resources, we also have internal guidance on diversity and inclusion and, crucially, access to a volunteer list of editors who act as sensitivity readers. Enlisting a sensitivity reader can have value in ensuring that harmful stereotypes or mischaracterizations can be avoided1. Sensitivity reading is separate to the detailed editing stage and the aim is to point out potentially insensitive language, avoid harm and provide feedback and recommendations to the handling editor and authors. Importantly, this step incorporates both the text and the figures or images used in the article.

Addressing language use is about balancing house style and sensitivity with author preference, intra-field nomenclature debates and changing norms. It is not simply enough to refer back to the language used in our historical articles, which might no longer be appropriate or even harmful; the journal must adapt and take a forward-looking approach. This issue is most paramount in discussions regarding changing disease nomenclature. There is ongoing and active debate regarding nonalcoholic fatty liver disease (NAFLD) and the proposal to adopt the new name and diagnostic criteria of metabolic-associated fatty liver disease (MAFLD), which has been suggested to better reflect the pathophysiology of the condition2. A unified nomenclature adopted by the entire community has yet to be achieved, and the outcome of the July 2022 consensus meeting on NAFLD nomenclature involving key stakeholders is eagerly awaited. This uncertainty regarding the nomenclature raises an issue for the journal as we are actively publishing content in this area. Although we have remained author-led with respect to the nomenclature used in the articles themselves, we have had to ensure that the name change debate and the potential change of diagnostic criteria2 is discussed in these articles for the benefit of our readers, ensuring scientific clarity and balancing fidelity to the language used in the cited original studies with newer literature that has adopted the MAFLD terminology. Peer review has also been an important tool to garner additional insights from experts in the field.

Although the journal is primarily aimed at those working within the basic, translational and clinical sciences, patients might also read our content, which is promoted on social media via our @NatRevGastroHep Twitter account and on the Nature Reviews Facebook page. In this regard, avoiding stigmatizing language becomes important. Stigma can result in discrimination and be a major barrier for disease prevention and public health measures3,4. As an example, all Nature Portfolio journals signed up to and support the pledge to end the social stigma of obesity4, and sensitive editing is needed to implement this pledge in practice, as evidenced by a recent article in which particular care was taken when discussing weight and obesity5.

As societal and medical norms shift, we as editors must also adapt. Internal guidance is currently being developed on sensitivity reading and inclusive language use, and the journal will continue to take a proactive approach to ensure our content is handled sensitively.