A multisociety Delphi consensus statement on new fatty liver disease nomenclature - PubMed (original) (raw)

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. 2023 Dec;79(6):1542-1556.

doi: 10.1016/j.jhep.2023.06.003. Epub 2023 Jun 24.

Jeffrey V Lazarus 2, Vlad Ratziu 3, Sven M Francque 4, Arun J Sanyal 5, Fasiha Kanwal 6, Diana Romero 7, Manal F Abdelmalek 8, Quentin M Anstee 9, Juan Pablo Arab 10, Marco Arrese 11, Ramon Bataller 12, Ulrich Beuers 13, Jerome Boursier 14, Elisabetta Bugianesi 15, Christopher D Byrne 16, Graciela E Castro Narro [ 17](#full-view-affiliation-17 "Latin 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, Mexico."), Abhijit Chowdhury 18, Helena Cortez-Pinto 19, Donna R Cryer 20, Kenneth Cusi 21, Mohamed El-Kassas 22, Samuel Klein 23, Wayne Eskridge 24, Jiangao Fan 25, Samer Gawrieh 26, Cynthia D Guy 27, Stephen A Harrison 28, Seung Up Kim 29, Bart G Koot 30, Marko Korenjak 31, Kris V Kowdley 32, Florence Lacaille 33, Rohit Loomba 34, Robert Mitchell-Thain 35, Timothy R Morgan 36, Elisabeth E Powell 37, Michael Roden 38, Manuel Romero-Gómez 39, Marcelo Silva 40, Shivaram Prasad Singh 41, Silvia C Sookoian 42, C Wendy Spearman 43, Dina Tiniakos 44, Luca Valenti 45, Miriam B Vos 46, Vincent Wai-Sun Wong 47, Stavra Xanthakos 48, Yusuf Yilmaz 49, Zobair Younossi 50, Ansley Hobbs 7, Marcela Villota-Rivas 51, Philip N Newsome 52; NAFLD Nomenclature consensus group

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A multisociety Delphi consensus statement on new fatty liver disease nomenclature

Mary E Rinella et al. J Hepatol. 2023 Dec.

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Abstract

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.

Keywords: ALD; Delphi; MASH; MASLD; Met-ALD; NAFLD; alcohol; metabolic; nomenclature; stigma.

Copyright © 2023 Mary E. Rinella, Jeffrey V. Lazarus, Vlad Ratziu, Sven M. Francque, Arun J. Sanyal, Fasiha Kanwal, Diana Romero, Manal F. Abdelmalek, Quentin M. Anstee, Juan Pablo Arab, Marco Arrese, Ramon Bataller, Ulrich Beuers, Jerome Boursier, Elisabetta Bugianesi, Christopher Byrne, Graciela E. Castro Narro, Abhijit Chowdhury, Helena Cortez-Pinto, Donna Cryer, Kenneth Cusi, Mohamed El-Kassas, Samuel Klein, Wayne Eskridge, Jiangao Fan, Samer Gawrieh, Cynthia D. Guy, Stephen A. Harrison, Seung Up Kim, Bart Koot, Marko Korenjak, Kris Kowdley, Florence Lacaille, Rohit Loomba, Robert Mitchell-Thain, Timothy R. Morgan, Elisabeth Powell, Michael Roden, Manuel Romero-Gómez, Marcelo Silva, Shivaram Prasad Singh, Silvia C. Sookoian, C. Wendy Spearman, Dina Tiniakos, Luca Valenti, Miriam B. Vos, Vincent Wai-Sun Wong, Stavra Xanthakos, Yusuf Yilmaz, Zobair Younossi, Ansley Hobbs, Marcela Villota-Rivas, Philip N. Newsome, NAFLD Nomenclature consensus group. Published by Elsevier B.V. All rights reserved.

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