A multisociety Delphi consensus statement on new fatty liver disease nomenclature

• Type of Material: Article
• Authors: Mary E. Rinella, University of Chicago; Jeffrey V. Lazarus, City University of New York; Vlad Ratziu, Hospital Pitié-Salpêtrière; Sven M. Francque, Antwerp University Hospital; Arun J. Sanyal, Virginia Commonwealth University; Fasiha Kanwal, Baylor College of Medicine; Diana Romero, City University of New York; Manal f. Abdelmalek, Mayo Clinic, Rochester; Quentin M. Anstee, Newcastle University; Juan Pablo Arab, Western University; Marco Arrese, Pontificia Universidad Catolica de Chile; Ramon Bataller, Institut d’Investigacions Biomediques August Pi i Sunyer; Ulrich Beuers, Amsterdam University; Jerome Boursier, Angers University; Elisabetta Bugianesi, University of Torino; Christopher D. Byrne, University of Southamptom; Graciela E. Castro Narro, Latin American Association for the Study of the Liver; Abhijit Chowdhury, Indian Institute of Liver and Digestive Sciences; Helena Cortez-Pinto, Universidade de Lisboa; Donna r. Cryer, Global Liver Institute; Kenneth Cusi, University of Florida, Gainesville; Mohamed El-Kassas, Helwen University; Samuel Klein, Washington University, St. Louis; Wayne Eskridge, Fatty Liver Foundation; Jiangao Fan, Shanghai Jiao Tong University; Samer Gawrieh, Indiana University; Cynthia D. Guy, Duke University; Stephen a. Harrison, University of Oxford; Seung Up Kim, Yonsei University; Bart G. Koot, University of Amsterdam; Marko Korenjak, European Liver Patients' Association; Kris V. Kowdley, Washington State University; florence Lacaille, Hôpital Universitaire Necker-Enfants Maladies; Rohit Loomba, University of California, San Diego; Robert Mitchell-Thain, Liver Patients International; Timothy R. Morgan, University of California, Irvine; Elisabeth E. Powell, University of Queensland; Michael Roden, Heinrich Heine University Düsseldorf; Manuel Romero-Gómez, University of Selville; Marcelo Silva, Austral University; Shivaram Prasad Singh, Kalinga Gastroenterology Foundation; Silvia C. Sookoian, Pontificia Universidad Catolica de Chile; C. Wendy Spearman, University of Cape Town; Dina Tiniakos, Newcastle University; Luca Valenti, Università degli Studi di Milano; Miriam Benedicta Vos, Emory University; Vincent Wai-Sun Wong, The Chinese University of Hong Kong; Stavra Xanthakos, University of Cincinnati; Yusuf Yilmaz, Recep Tayyip Erdoğan University; Zobair Younossi, Inova Fairfax Medical Campus; Ansley Hobbs, City University of New York; Marcela Villota-Rivas, University of Barcelona; Philip N. Newsome, University of Birmingham
• Language: English
• Date: 2023-06-24
• Publisher: Wolters Kluwer
• Publication Version: Final Published Version
• Copyright Statement: © 2023 American Association for the Study of Liver Disease, European Association for the Study of the Liver (EASL), and Fundación Clínica Médica Sur, A.C. Published by Wolters Kluwer/Elsevier B.V/Elsevier España, S.L.U.
• Final Published Version (URL): https://doi.org/10.1097/HEP.0000000000000520
• Title of Journal or Parent Work: Hepatology
• Volume: 78
• Issue: 6
• Start Page: 1966
• End Page: 1986
• Keywords: non-alcoholic steatohepatitis; Delphi process; metabolic and alcohol related/associated liver disease; non-alcoholic fatty liver disease
• Research Categories: Health Sciences, Public Health

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.