A multisociety Delphi consensus statement on new fatty liver disease nomenclature
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 D...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268123002375 |
| _version_ | 1827778558154506240 |
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| author | 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 D. Byrne Graciela E. Castro Narro Abhijit Chowdhury Helena Cortez-Pinto Donna R. Cryer Kenneth Cusi Mohamed El-Kassas Samuel Klein Wayne Eskridge Jiangao Fan Samer Gawrieh Cynthia D. Guy Stephen A. Harrison Seung Up Kim Bart G. Koot Marko Korenjak Kris V. Kowdley Florence Lacaille Rohit Loomba Robert Mitchell-Thain Timothy R. Morgan Elisabeth E. 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 |
| author_facet | 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 D. Byrne Graciela E. Castro Narro Abhijit Chowdhury Helena Cortez-Pinto Donna R. Cryer Kenneth Cusi Mohamed El-Kassas Samuel Klein Wayne Eskridge Jiangao Fan Samer Gawrieh Cynthia D. Guy Stephen A. Harrison Seung Up Kim Bart G. Koot Marko Korenjak Kris V. Kowdley Florence Lacaille Rohit Loomba Robert Mitchell-Thain Timothy R. Morgan Elisabeth E. 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 |
| author_sort | Mary E. Rinella |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T14:36:15Z |
| format | Article |
| id | doaj.art-f02c612b79da4aaa8837228f72393227 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-03-11T14:36:15Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-f02c612b79da4aaa8837228f723932272023-10-31T04:08:56ZengElsevierAnnals of Hepatology1665-26812024-01-01291101133A multisociety Delphi consensus statement on new fatty liver disease nomenclatureMary E. Rinella0Jeffrey V. Lazarus1Vlad Ratziu2Sven M. Francque3Arun J. Sanyal4Fasiha Kanwal5Diana Romero6Manal F. Abdelmalek7Quentin M. Anstee8Juan Pablo Arab9Marco Arrese10Ramon Bataller11Ulrich Beuers12Jerome Boursier13Elisabetta Bugianesi14Christopher D. Byrne15Graciela E. Castro Narro16Abhijit Chowdhury17Helena Cortez-Pinto18Donna R. Cryer19Kenneth Cusi20Mohamed El-Kassas21Samuel Klein22Wayne Eskridge23Jiangao Fan24Samer Gawrieh25Cynthia D. Guy26Stephen A. Harrison27Seung Up Kim28Bart G. Koot29Marko Korenjak30Kris V. Kowdley31Florence Lacaille32Rohit Loomba33Robert Mitchell-Thain34Timothy R. Morgan35Elisabeth E. Powell36Michael Roden37Manuel Romero-Gómez38Marcelo Silva39Shivaram Prasad Singh40Silvia C. Sookoian41C. Wendy Spearman42Dina Tiniakos43Luca Valenti44Miriam B. Vos45Vincent Wai-Sun Wong46Stavra Xanthakos47Yusuf Yilmaz48Zobair Younossi49Ansley Hobbs50Marcela Villota-Rivas51Philip N. Newsome52University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA; Correspondence Mary E. Rinella, University of Chicago, Pritzker School of Medicine, Chicago, Illinois 60637, USA.City 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, SpainSorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, FranceDepartment 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, BelgiumVirginia Commonwealth University, Richmond, Virginia, USASections 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, USACity University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USAMayo Clinic, Rochester, Minnesota, USATranslational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UKDivision 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, ChileDepartamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Latin American Association for the Study of the Liver (ALEH) Santiago, ChileLiver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, SpainDepartment of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Location AMC, Amsterdam, The NetherlandsHepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France & HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, FranceDepartment of Medical Sciences, University of Torino, Torino, ItalyNutrition 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, UKLatin 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, MexicoIndian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India; John C. Martin Centre for Liver Research and Innovations, Sonarpur, Kolkata, IndiaClínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PortugalGlobal Liver Institute, Washington, District of Columbia, USADivision of Endocrinology, Diabetes and Metabolism, The University of Florida, Gainesville, Florida, USAEndemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, EgyptWashington University School of Medicine, St. Louis, Missouri, USAFatty Liver Foundation, Boise, Idaho, USAXinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USADepartment of Pathology, Duke Health Systems, Durham, North Carolina, USARadcliffe Department of Medicine, University of Oxford, Oxford, UKYonsei University College of Medicine, Seoul, KoreaDepartment of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The NetherlandsEuropean Liver Patients’ Association, Brussels, BelgiumLiver Institute Northwest Elson S. Floyd College of Medicine Washington State University Seattle, Washington, USAHôpital Universitaire Necker-Enfants Maladies, Paris, FranceNAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USAPBC Foundation, Liver Patients International, Edinburgh, ScotlandMedical Service, VA Long Beach Healthcare System, Long Beach, California, USA; Department of Medicine, University of California, Irvine, California, USACentre 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, AustraliaDepartment 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, GermanyDigestive Diseases and Ciberehd, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville, Seville, SpainAustral University Hospital, Buenos Aires, ArgentinaKalinga Gastroenterology Foundation, Cuttack, Odisha, IndiaDepartamento 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, ArgentinaDivision of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaTranslational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GreeceDepartment 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, ItalyDivision of Gastroenterology, Department of Paediatrics, Hepatology and Nutrition, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USADepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, ChinaDepartment of paediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USADepartment of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, TurkeyInova 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 StatesCity University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USABarcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, SpainNational 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; Correspondence Philip N. Newsome, National Institute for Health Research Birmingham Biomedical Research Centre and Centre for Liver & Gastrointestinal Research, 5th Floor Institute of Biomedical Research, University of Birmingham, Birmingham, B15 2TT, UK.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.http://www.sciencedirect.com/science/article/pii/S1665268123002375 |
| spellingShingle | 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 D. Byrne Graciela E. Castro Narro Abhijit Chowdhury Helena Cortez-Pinto Donna R. Cryer Kenneth Cusi Mohamed El-Kassas Samuel Klein Wayne Eskridge Jiangao Fan Samer Gawrieh Cynthia D. Guy Stephen A. Harrison Seung Up Kim Bart G. Koot Marko Korenjak Kris V. Kowdley Florence Lacaille Rohit Loomba Robert Mitchell-Thain Timothy R. Morgan Elisabeth E. 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 A multisociety Delphi consensus statement on new fatty liver disease nomenclature Annals of Hepatology |
| title | A multisociety Delphi consensus statement on new fatty liver disease nomenclature |
| title_full | A multisociety Delphi consensus statement on new fatty liver disease nomenclature |
| title_fullStr | A multisociety Delphi consensus statement on new fatty liver disease nomenclature |
| title_full_unstemmed | A multisociety Delphi consensus statement on new fatty liver disease nomenclature |
| title_short | A multisociety Delphi consensus statement on new fatty liver disease nomenclature |
| title_sort | multisociety delphi consensus statement on new fatty liver disease nomenclature |
| url | http://www.sciencedirect.com/science/article/pii/S1665268123002375 |
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