A multi-society Delphi consensus statement on new fatty liver disease nomenclature

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; Luca Miele; NAFLD Nomenclature consensus group

doi:10.1097/HEP.0000000000000520

A multi-society Delphi consensus statement on new fatty liver disease nomenclature

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 CryerKenneth 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^*, Luca Miele, NAFLD Nomenclature consensus group

^*Corresponding author

Research output: Contribution to journal › Article

Abstract

Unlabelled: The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (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. Methods: A modified Delphi process was led by three large pan-national liver associations. 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. Results: A total of 236 panellists from 56 countries participated in four online surveys and two hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83% and 78%, respectively. 74% of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms 'non-alcoholic' and 'fatty' were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease (SLD) 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 one of five cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic SLD. A new category, outside pure MASLD, termed MetALD was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 to 350 g/week and 210 to 420 g/week for females and males respectively). Conclusions: The new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.

Original language	English
Pages (from-to)	N/A-N/A
Journal	Hepatology
Volume	Publish Ahead of Print
Issue number	N/A
DOIs	https://doi.org/10.1097/HEP.0000000000000520
Publication status	Published - 2023

All Science Journal Classification (ASJC) codes

Hepatology

Keywords

N/A

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10.1097/HEP.0000000000000520

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Rinella, M. E., Lazarus, J. V., Ratziu, V., Francque, S. M., Sanyal, A. J., Kanwal, F., Romero, D., Abdelmalek, M. F., Anstee, Q. M., Arab, J. P., Arrese, M., Bataller, R., Beuers, U., Boursier, J., Bugianesi, E., Byrne, C., Castro Narro, G. E., Chowdhury, A., Cortez-Pinto, H., ... group, NAFLD. N. C. (2023). A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, Publish Ahead of Print(N/A), N/A-N/A. https://doi.org/10.1097/HEP.0000000000000520

@article{b0317df097d8486eabe90df02dcf5656,

title = "A multi-society Delphi consensus statement on new fatty liver disease nomenclature",

abstract = "Unlabelled: The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (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. Methods: A modified Delphi process was led by three large pan-national liver associations. 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. Results: A total of 236 panellists from 56 countries participated in four online surveys and two hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83% and 78%, respectively. 74% of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms 'non-alcoholic' and 'fatty' were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease (SLD) 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 one of five cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic SLD. A new category, outside pure MASLD, termed MetALD was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 to 350 g/week and 210 to 420 g/week for females and males respectively). Conclusions: The new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.",

keywords = "N/A, N/A",

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

year = "2023",

doi = "10.1097/HEP.0000000000000520",

language = "English",

volume = "Publish Ahead of Print",

pages = "N/A--N/A",

journal = "Hepatology",

issn = "0270-9139",

publisher = "Lippincott Williams and Wilkins",

number = "N/A",

}

Rinella, ME, Lazarus, JV, Ratziu, V, Francque, SM, Sanyal, AJ, Kanwal, F, Romero, D, Abdelmalek, MF, Anstee, QM, Arab, JP, Arrese, M, Bataller, R, Beuers, U, Boursier, J, Bugianesi, E, Byrne, C, Castro Narro, GE, Chowdhury, A, Cortez-Pinto, H, Cryer, D, Cusi, K, El-Kassas, M, Klein, S, Eskridge, W, Fan, J, Gawrieh, S, Guy, CD, Harrison, SA, Kim, SU, Koot, B, Korenjak, M, Kowdley, K, Lacaille, F, Loomba, R, Mitchell-Thain, R, Morgan, TR, Powell, E, Roden, M, Romero-Gómez, M, Silva, M, Singh, SP, Sookoian, SC, Spearman, CW, Tiniakos, D, Valenti, L, Vos, MB, Wong, VW-S, Xanthakos, S, Yilmaz, Y, Younossi, Z, Hobbs, A, Villota-Rivas, M, Newsome, PN, Miele, L & group, NAFLDNC 2023, 'A multi-society Delphi consensus statement on new fatty liver disease nomenclature', Hepatology, vol. Publish Ahead of Print, no. N/A, pp. N/A-N/A. https://doi.org/10.1097/HEP.0000000000000520

TY - JOUR

T1 - A multi-society Delphi consensus statement on new fatty liver disease nomenclature

AU - Rinella, Mary E

AU - Lazarus, Jeffrey V

AU - Ratziu, Vlad

AU - Francque, Sven M

AU - Sanyal, Arun J

AU - Kanwal, Fasiha

AU - Romero, Diana

AU - Abdelmalek, Manal F

AU - Anstee, Quentin M

AU - Arab, Juan Pablo

AU - Arrese, Marco

AU - Bataller, Ramon

AU - Beuers, Ulrich

AU - Boursier, Jerome

AU - Bugianesi, Elisabetta

AU - Byrne, Christopher

AU - Castro Narro, Graciela E

AU - Chowdhury, Abhijit

AU - Cortez-Pinto, Helena

AU - Cryer, Donna

AU - Cusi, Kenneth

AU - El-Kassas, Mohamed

AU - Klein, Samuel

AU - Eskridge, Wayne

AU - Fan, Jiangao

AU - Gawrieh, Samer

AU - Guy, Cynthia D

AU - Harrison, Stephen A

AU - Kim, Seung Up

AU - Koot, Bart

AU - Korenjak, Marko

AU - Kowdley, Kris

AU - Lacaille, Florence

AU - Loomba, Rohit

AU - Mitchell-Thain, Robert

AU - Morgan, Timothy R

AU - Powell, Elisabeth

AU - Roden, Michael

AU - Romero-Gómez, Manuel

AU - Silva, Marcelo

AU - Singh, Shivaram Prasad

AU - Sookoian, Silvia C

AU - Spearman, C Wendy

AU - Tiniakos, Dina

AU - Valenti, Luca

AU - Vos, Miriam B

AU - Wong, Vincent Wai-Sun

AU - Xanthakos, Stavra

AU - Yilmaz, Yusuf

AU - Younossi, Zobair

AU - Hobbs, Ansley

AU - Villota-Rivas, Marcela

AU - Newsome, Philip N

AU - Miele, Luca

AU - group, NAFLD Nomenclature consensus

PY - 2023

Y1 - 2023

N2 - Unlabelled: The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (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. Methods: A modified Delphi process was led by three large pan-national liver associations. 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. Results: A total of 236 panellists from 56 countries participated in four online surveys and two hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83% and 78%, respectively. 74% of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms 'non-alcoholic' and 'fatty' were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease (SLD) 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 one of five cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic SLD. A new category, outside pure MASLD, termed MetALD was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 to 350 g/week and 210 to 420 g/week for females and males respectively). Conclusions: The new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.

AB - Unlabelled: The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (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. Methods: A modified Delphi process was led by three large pan-national liver associations. 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. Results: A total of 236 panellists from 56 countries participated in four online surveys and two hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83% and 78%, respectively. 74% of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms 'non-alcoholic' and 'fatty' were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease (SLD) 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 one of five cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic SLD. A new category, outside pure MASLD, termed MetALD was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 to 350 g/week and 210 to 420 g/week for females and males respectively). Conclusions: The new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.

KW - N/A

UR - https://publicatt.unicatt.it/handle/10807/245116

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U2 - 10.1097/HEP.0000000000000520

DO - 10.1097/HEP.0000000000000520

M3 - Article

SN - 0270-9139

VL - Publish Ahead of Print

SP - N/A-N/A

JO - Hepatology

JF - Hepatology

IS - N/A

ER -

A multi-society Delphi consensus statement on new fatty liver disease nomenclature

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