A multisociety Delphi consensus statement on new fatty liver disease nomenclature-Reference-Cited by-同舟云学术

A multisociety Delphi consensus statement on new fatty liver disease nomenclature

Published:2023-06-24 Issue:6 Volume:78 Page:1966-1986
ISSN:0270-9139
Container-title:Hepatology
language:en
Short-container-title:

Author:

Rinella Mary E.¹,Lazarus Jeffrey V.²³,Ratziu Vlad⁴,Francque Sven M.⁵⁶,Sanyal Arun J.⁷,Kanwal Fasiha⁸⁹,Romero Diana²,Abdelmalek Manal F.¹⁰,Anstee Quentin M.¹¹¹²,Arab Juan Pablo¹³¹⁴¹⁵,Arrese Marco¹⁵¹⁶,Bataller Ramon¹⁷,Beuers Ulrich¹⁸,Boursier Jerome¹⁹,Bugianesi Elisabetta²⁰,Byrne Christopher D.²¹²²,Castro Narro Graciela E.¹⁶²³²⁴,Chowdhury Abhijit²⁵²⁶,Cortez-Pinto Helena²⁷,Cryer Donna R.²⁸,Cusi Kenneth²⁹,El-Kassas Mohamed³⁰,Klein Samuel³¹,Eskridge Wayne³²,Fan Jiangao³³,Gawrieh Samer³⁴,Guy Cynthia D.³⁵,Harrison Stephen A.³⁶,Kim Seung Up³⁷,Koot Bart G.³⁸,Korenjak Marko³⁹,Kowdley Kris V.⁴⁰,Lacaille Florence⁴¹,Loomba Rohit⁴²,Mitchell-Thain Robert⁴³,Morgan Timothy R.⁴⁴⁴⁵,Powell Elisabeth E.⁴⁶⁴⁷⁴⁸,Roden Michael⁴⁹⁵⁰⁵¹,Romero-Gómez Manuel⁵²,Silva Marcelo⁵³,Singh Shivaram Prasad⁵⁴,Sookoian Silvia C.¹⁵⁵⁵⁵⁶,Spearman C. Wendy⁵⁷,Tiniakos Dina¹¹⁵⁸,Valenti Luca⁵⁹⁶⁰,Vos Miriam B.⁶¹,Wong Vincent Wai-Sun⁶²,Xanthakos Stavra⁶³,Yilmaz Yusuf⁶⁴,Younossi Zobair⁶⁵⁶⁶⁶⁷,Hobbs Ansley²,Villota-Rivas Marcela⁶⁸,Newsome Philip N.⁶⁹⁷⁰,

Affiliation:

1. University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA

2. City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA

3. Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain

4. Sorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, France

5. Department of Gastroenterology Hepatology, Antwerp University Hospital, Edegem, Belgium

6. 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, Belgium

7. Virginia Commonwealth University, Richmond, Virginia, USA

8. Sections of Gastroenterology and Hepatology and Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

9. VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA

10. Mayo Clinic, Rochester, Minnesota, USA

11. Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

12. Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK

13. Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada

14. Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada

15. Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile

16. Latin American Association for the Study of the Liver (ALEH) Santiago, Chile

17. Liver Unit, Hospital Clinic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

18. Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands

19. Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France & HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, France

20. Department of Medical Sciences, University of Torino, Torino, Italy

21. Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK

22. National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK

23. Hepatology and Transplant Unit, Hospital Médica Sur, Mexico City, Mexico

24. Department of Gastroenterology, National Institute of Medical Sciences and Nutrition “Salvador Zubirán” Mexico City, Mexico

25. Indian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India

26. John C. Martin Centre for Liver Research and Innovations, Sonarpur, Kolkata, India

27. Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal

28. Global Liver Institute, Washington, District of Columbia, USA

29. Division of Endocrinology, Diabetes and Metabolism, The University of Florida, Gainesville, Florida, USA

30. Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt

31. Washington University School of Medicine, St. Louis, Missouri, USA

32. Fatty Liver Foundation, Boise, Idaho, USA

33. Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

34. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA

35. Department of Pathology, Duke Health Systems, Durham, North Carolina, USA

36. Radcliffe Department of Medicine, University of Oxford, Oxford, UK

37. Yonsei University College of Medicine, Seoul, Korea

38. Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

39. European Liver Patients’ Association, Brussels, Belgium

40. Liver Institute Northwest Elson S. Floyd College of Medicine Washington State University Seattle, Washington, USA

41. Hôpital Universitaire Necker-Enfants Maladies, Paris, France

42. NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA

43. PBC Foundation, Liver Patients International, Edinburgh, Scotland

44. Medical Service, VA Long Beach Healthcare System, Long Beach, California, USA

45. Department of Medicine, University of California, Irvine, California, USA

46. Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia

47. QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia

48. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

49. Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

50. Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany

51. German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany

52. Digestive Diseases and Ciberehd, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville, Seville, Spain

53. Austral University Hospital, Buenos Aires, Argentina

54. Kalinga Gastroenterology Foundation, Cuttack, Odisha, India

55. 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

56. Universidad Maimónides, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina

57. Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

58. Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

59. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy

60. Biological Resource Center Unit, Precision Medicine lab, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy

61. Division of Gastroenterology, Department of Paediatrics, Hepatology and Nutrition, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA

62. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China

63. Department of paediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children’s, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

64. Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey

65. Inova Medicine, Inova Health System, Falls Church, Virginia, USA

66. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States

67. Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States

68. Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain

69. National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK

70. Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK

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 favor 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 panelists 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. 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 nonstigmatising, and can improve awareness and patient identification.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Hepatology

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