A multi-society Delphi consensus statement on new fatty liver disease nomenclature.
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Author
Rinella, Mary ELazarus, Jeffrey V
Ratziu, Vlad
Francque, Sven M
Sanyal, Arun J
Kanwal, Fasiha
Romero, Diana
Abdelmalek, Manal F
Anstee, Quentin M
Arab, Juan Pablo
Arrese, Marco
Bataller, Ramon
Beuers, Ulrich
Boursier, Jerome
Bugianesi, Elisabetta
Byrne, Christopher
Castro Narro, Graciela E
Chowdhury, Abhijit
Cortez-Pinto, Helena
Cryer, Donna
Cusi, Kenneth
El-Kassas, Mohamed
Klein, Samuel
Eskridge, Wayne
Fan, Jiangao
Gawrieh, Samer
Guy, Cynthia D
Harrison, Stephen A
Kim, Seung Up
Koot, Bart
Korenjak, Marko
Kowdley, Kris
Lacaille, Florence
Loomba, Rohit
Mitchell-Thain, Robert
Morgan, Timothy R
Powell, Elisabeth
Roden, Michael
Romero-Gómez, Manuel
Silva, Marcelo
Singh, Shivaram Prasad
Sookoian, Silvia C
Spearman, C Wendy
Tiniakos, Dina
Valenti, Luca
Vos, Miriam B
Wai-Sun Wong, Vincent
Xanthakos, Stavra
Yilmaz, Yusuf
Younossi, Zobair
Hobbs, Ansley
Villota-Rivas, Marcela
Newsome, Philip N
Publication date
2023-06-20Subject
Gastroenterology
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Show full item recordAbstract
The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (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. Methods: A modified Delphi process was led by three large pan-national liver associations. 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. Results: A total of 236 panellists from 56 countries participated in four online surveys and two hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83% and 78%, respectively. 74% of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms 'non-alcoholic' and 'fatty' were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease (SLD) 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 one of five cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic SLD. A new category, outside pure MASLD, termed MetALD was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 to 350 g/week and 210 to 420 g/week for females and males respectively). Conclusions: The new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.Citation
Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M, Bataller R, Beuers U, Boursier J, Bugianesi E, Byrne C, Castro Narro GE, Chowdhury A, Cortez-Pinto H, Cryer D, Cusi K, El-Kassas M, Klein S, Eskridge W, Fan J, Gawrieh S, Guy CD, Harrison SA, Kim SU, Koot B, Korenjak M, Kowdley K, Lacaille F, Loomba R, Mitchell-Thain R, Morgan TR, Powell E, Roden M, Romero-Gómez M, Silva M, Singh SP, Sookoian SC, Spearman CW, Tiniakos D, Valenti L, Vos MB, Wai-Sun Wong V, Xanthakos S, Yilmaz Y, Younossi Z, Hobbs A, Villota-Rivas M, Newsome PN; NAFLD Nomenclature consensus group. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023 Jun 20:S0168-8278(23)00418-X. doi: 10.1016/j.jhep.2023.06.003. Epub ahead of print.Type
ArticleAdditional Links
http://www.sciencedirect.com/science/journal/01688278PMID
37364790Journal
Journal of HepatologyPublisher
Elsevierae974a485f413a2113503eed53cd6c53
10.1016/j.jhep.2023.06.003