A multisociety Delphi consensus statement on new fatty liver disease nomenclature
Mary E. RinellaUniversity of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA. Electronic address: [email protected]Jeffrey V. LazarusCity University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA; Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, SpainVlad RatziuSorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, FranceSven FrancqueDepartment of Gastroenterology Hepatology, Antwerp University Hospital, Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, BelgiumArun J. SanyalVirginia Commonwealth University, Richmond, Virginia, USAFasiha KanwalSections of Gastroenterology and Hepatology and Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USADiana RomeroCity University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USAManal F. AbdelmalekMayo Clinic, Rochester, Minnesota, USAQuentin M. AnsteeTranslational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UKJuan Pablo ArabDivision of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada; Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, ChileMarco ArreseDepartamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Latin American Association for the Study of the Liver (ALEH) Santiago, ChileRamón BatallerLiver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, SpainUlrich BeuersDepartment of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Location AMC, Amsterdam, The NetherlandsJérôme BoursierHepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France & HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, FranceElisabetta BugianesiDepartment of Medical Sciences, University of Torino, Torino, ItalyChristopher D. ByrneNutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UKGraciela Castro‐NarroLatin American Association for the Study of the Liver (ALEH) Santiago, Chile; Hepatology and Transplant Unit, Hospital Médica Sur, Mexico City, Mexico; Department of Gastroenterology, National Institute of Medical Sciences and Nutrition "Salvador Zubirán" Mexico City, MexicoAbhijit ChowdhuryHelena Cortez‐PintoClínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PortugalDonna R. CryerGlobal Liver Institute, Washington, District of Columbia, USAKenneth CusiDivision of Endocrinology, Diabetes and Metabolism, The University of Florida, Gainesville, Florida, USAMohamed El‐KassasEndemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, EgyptSamuel KleinWashington University School of Medicine, St. Louis, Missouri, USAWayne EskridgeJian‐Gao FanXinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaSamer GawriehDivision of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USACynthia D. GuyDepartment of Pathology, Duke Health Systems, Durham, North Carolina, USAStephen A. HarrisonRadcliffe Department of Medicine, University of Oxford, Oxford, UKSeung Up KimYonsei University College of Medicine, Seoul, KoreaBart G.P. KootDepartment of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The NetherlandsMarko KorenjakEuropean Liver Patients' Association, Brussels, BelgiumKris V. KowdleyLiver Institute Northwest Elson S. Floyd College of Medicine Washington State University Seattle, Washington, USAFlorence LacailleHôpital Universitaire Necker-Enfants Maladies, Paris, FranceRohit LoombaNAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USARobert Mitchell-ThainPBC Foundation, Liver Patients International, Edinburgh, ScotlandTimothy R. MorganMedical Service, VA Long Beach Healthcare System, Long Beach, California, USA; Department of Medicine, University of California, Irvine, California, USAElisabeth E. PowellCentre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaMichael RodenDepartment of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, GermanyManuel Romero‐GómezDigestive Diseases and Ciberehd, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville, Seville, SpainMarcelo SilvaAustral University Hospital, Buenos Aires, ArgentinaShivaram Prasad SinghSilvia SookoianDepartamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Clinical and Molecular Hepatology, Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Universidad Maimónides, Ciudad Autónoma de Buenos Aires, Buenos Aires, ArgentinaC Wendy SpearmanDivision of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaDina TiniakosTranslational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GreeceLuca ValentiDepartment of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Biological Resource Center Unit, Precision Medicine lab, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, ItalyMiriam B. VosDivision of Gastroenterology, Department of Paediatrics, Hepatology and Nutrition, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USAVincent Wai‐Sun WongDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, ChinaStavra A. XanthakosDepartment of paediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USAYusuf YılmazDepartment of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, TurkeyZobair M. YounossiInova Medicine, Inova Health System, Falls Church, Virginia, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United StatesAnsley HobbsCity University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USAMarcela Villota‐RivasBarcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, SpainPhilip N. NewsomeNational Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK; Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK. Electronic address: [email protected]
2023en
ABI
Аннотация
The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favour of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panellists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease (MASLD). There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and non-stigmatising, and can improve awareness and patient identification.
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