A multisociety Delphi consensus statement on new fatty liver disease nomenclature

Mary E Rinella¹, Jeffrey V Lazarus², Vlad Ratziu³, Sven M Francque⁴, Arun J Sanyal⁵, Fasiha Kanwal⁶, Diana Romero⁷, Manal F Abdelmalek⁸, Quentin M Anstee⁹, Juan Pablo Arab¹⁰, Marco Arrese¹¹, Ramon Bataller¹², Ulrich Beuers¹³, Jerome Boursier¹⁴, Elisabetta Bugianesi¹⁵, Christopher D Byrne¹⁶, Graciela E Castro Narro¹⁷, Abhijit Chowdhury¹⁸, Helena Cortez-Pinto¹⁹, Donna R Cryer²⁰, Kenneth Cusi²¹, Mohamed El-Kassas²², Samuel Klein²³, Wayne Eskridge²⁴, Jiangao Fan²⁵, Samer Gawrieh²⁶, Cynthia D Guy²⁷, Stephen A Harrison²⁸, Seung Up Kim²⁹, Bart G Koot³⁰, Marko Korenjak³¹, Kris V Kowdley³², Florence Lacaille³³, Rohit Loomba³⁴, Robert Mitchell-Thain³⁵, Timothy R Morgan³⁶, Elisabeth E Powell³⁷, Michael Roden³⁸, Manuel Romero-Gómez³⁹, Marcelo Silva⁴⁰, Shivaram Prasad Singh⁴¹, Silvia C Sookoian⁴², C Wendy Spearman⁴³, Dina Tiniakos⁴⁴, Luca Valenti⁴⁵, Miriam B Vos⁴⁶, Vincent Wai-Sun Wong⁴⁷, Stavra Xanthakos⁴⁸, Yusuf Yilmaz⁴⁹, Zobair Younossi⁵⁰, Ansley Hobbs⁷, Marcela Villota-Rivas⁵¹, Philip N Newsome⁵²; NAFLD Nomenclature consensus group

Affiliations

¹ University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA. Electronic address: mrinella@bsd.uchicago.edu.
² 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, Spain.
³ Sorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, France.
⁴ Department 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, Belgium.
⁵ Virginia Commonwealth University, Richmond, Virginia, USA.
⁶ Sections 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, USA.
⁷ City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA.
⁸ Mayo Clinic, Rochester, Minnesota, USA.
⁹ Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
¹⁰ Division 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, Chile.
¹¹ Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Latin American Association for the Study of the Liver (ALEH) Santiago, Chile.
¹² Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹³ Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
¹⁴ Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France & HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, France.
¹⁵ Department of Medical Sciences, University of Torino, Torino, Italy.
¹⁶ Nutrition 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, UK.
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.
¹⁸ Indian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India; John C. Martin Centre for Liver Research and Innovations, Sonarpur, Kolkata, India.
¹⁹ Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
²⁰ Global Liver Institute, Washington, District of Columbia, USA.
²¹ Division of Endocrinology, Diabetes and Metabolism, The University of Florida, Gainesville, Florida, USA.
²² Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
²³ Washington University School of Medicine, St. Louis, Missouri, USA.
²⁴ Fatty Liver Foundation, Boise, Idaho, USA.
²⁵ Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁶ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
²⁷ Department of Pathology, Duke Health Systems, Durham, North Carolina, USA.
²⁸ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
²⁹ Yonsei University College of Medicine, Seoul, Korea.
³⁰ Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³¹ European Liver Patients' Association, Brussels, Belgium.
³² Liver Institute Northwest Elson S. Floyd College of Medicine Washington State University Seattle, Washington, USA.
³³ Hôpital Universitaire Necker-Enfants Maladies, Paris, France.
³⁴ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
³⁵ PBC Foundation, Liver Patients International, Edinburgh, Scotland.
³⁶ Medical Service, VA Long Beach Healthcare System, Long Beach, California, USA; Department of Medicine, University of California, Irvine, California, USA.
³⁷ Centre 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, Australia.
³⁸ Department 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, Germany.
³⁹ Digestive Diseases and Ciberehd, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville, Seville, Spain.
⁴⁰ Austral University Hospital, Buenos Aires, Argentina.
⁴¹ Kalinga Gastroenterology Foundation, Cuttack, Odisha, India.
⁴² Departamento 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, Argentina.
⁴³ Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁴⁴ Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁴⁵ Department 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, Italy.
⁴⁶ Division of Gastroenterology, Department of Paediatrics, Hepatology and Nutrition, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁴⁷ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
⁴⁸ Department of paediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁴⁹ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
⁵⁰ Inova 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 States.
⁵¹ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
⁵² National 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. Electronic address: p.n.newsome@bham.ac.uk.

PMID: 37364790
DOI: 10.1016/j.jhep.2023.06.003

Free article

Review

A multisociety Delphi consensus statement on new fatty liver disease nomenclature

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

Free article

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

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

Authors

Affiliations

¹ University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA. Electronic address: mrinella@bsd.uchicago.edu.
² 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, Spain.
³ Sorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, France.
⁴ Department 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, Belgium.
⁵ Virginia Commonwealth University, Richmond, Virginia, USA.
⁶ Sections 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, USA.
⁷ City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA.
⁸ Mayo Clinic, Rochester, Minnesota, USA.
⁹ Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
¹⁰ Division 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, Chile.
¹¹ Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Latin American Association for the Study of the Liver (ALEH) Santiago, Chile.
¹² Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹³ Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
¹⁴ Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France & HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, France.
¹⁵ Department of Medical Sciences, University of Torino, Torino, Italy.
¹⁶ Nutrition 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, UK.
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.
¹⁸ Indian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India; John C. Martin Centre for Liver Research and Innovations, Sonarpur, Kolkata, India.
¹⁹ Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
²⁰ Global Liver Institute, Washington, District of Columbia, USA.
²¹ Division of Endocrinology, Diabetes and Metabolism, The University of Florida, Gainesville, Florida, USA.
²² Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
²³ Washington University School of Medicine, St. Louis, Missouri, USA.
²⁴ Fatty Liver Foundation, Boise, Idaho, USA.
²⁵ Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁶ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
²⁷ Department of Pathology, Duke Health Systems, Durham, North Carolina, USA.
²⁸ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
²⁹ Yonsei University College of Medicine, Seoul, Korea.
³⁰ Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³¹ European Liver Patients' Association, Brussels, Belgium.
³² Liver Institute Northwest Elson S. Floyd College of Medicine Washington State University Seattle, Washington, USA.
³³ Hôpital Universitaire Necker-Enfants Maladies, Paris, France.
³⁴ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
³⁵ PBC Foundation, Liver Patients International, Edinburgh, Scotland.
³⁶ Medical Service, VA Long Beach Healthcare System, Long Beach, California, USA; Department of Medicine, University of California, Irvine, California, USA.
³⁷ Centre 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, Australia.
³⁸ Department 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, Germany.
³⁹ Digestive Diseases and Ciberehd, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville, Seville, Spain.
⁴⁰ Austral University Hospital, Buenos Aires, Argentina.
⁴¹ Kalinga Gastroenterology Foundation, Cuttack, Odisha, India.
⁴² Departamento 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, Argentina.
⁴³ Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁴⁴ Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁴⁵ Department 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, Italy.
⁴⁶ Division of Gastroenterology, Department of Paediatrics, Hepatology and Nutrition, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁴⁷ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
⁴⁸ Department of paediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁴⁹ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
⁵⁰ Inova 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 States.
⁵¹ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
⁵² National 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. Electronic address: p.n.newsome@bham.ac.uk.

PMID: 37364790
DOI: 10.1016/j.jhep.2023.06.003

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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Comment in

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A multisociety Delphi consensus statement on new fatty liver disease nomenclature

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A multisociety Delphi consensus statement on new fatty liver disease nomenclature

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