'New Affirmative And Non-Stigmatizing "Fatty" Liver Disease Nomenclature announced by Multinational Liver Societies

Written By : Dr. Kamal Kant Kohli Published On 2023-08-10T09:15:45+05:30 | Updated On 10 Aug 2023 4:08 PM IST

USA: The multinational liver societies leaders from La Asociacion Latinoamericana para el Estudio del Hígado (ALEH), American Association for the Study of Liver Diseases (AASLD), and European Association for the Study of the Liver (EASL) as well as the co-chairs of the NAFLD Nomenclature Initiative announced New “Fatty” Liver Disease Nomenclature at At EASL Congress 2023.

The multinational liver societies together with patient advocacy groups had convened and endorsed a global nomenclature group in 2020 to review naming and definition options for NAFLD. The report was published on June 24 in Hepatology.

According to new nomenclature steatotic liver disease (SLD) was chosen as an overarching term to encompass the various aetiologies of steatosis. Further it was felt that term steatohepatitis should be retainedas it was an important pathophysiological concept.

Nonalcoholic fatty liver disease (NAFLD) will be termed as metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD encompasses patients who have hepatic steatosis and have at least one of five cardiometabolic risk factors.

It was decided that a new category termed MetALD be selected to describe those with MASLD who consume greater amounts of alcohol per week (140 g/week and 210 g/week for females and males respectively) outside of pure MASLD,.

Those with no metabolic parameters and no known cause have cryptogenic SLD. Nonalcoholic steatohepatitis (NASH) shall be replaced by the term Metabolic dysfunction-associated steatohepatitis (MASH).

In the report published in the journal Hepatology, the panellists, members of the NAFLD Nomenclature Consensus Group, determined that steatotic liver disease (SLD) would be used as an "overarching term to encompass the various etiologies of steatosis."

The renaming comes after a two-year process led by the American Association for the Study of Liver Disease (AASLD) and the European Association for the Study of the Liver (EASL).

The report stated, "Identification of a new definition and name for the condition formerly known as nonalcoholic fatty liver disease has been a challenging process provided the broad range of global stakeholders."

Mary E Rinella, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA, and colleagues stress that it is imperative that any new proposal be better than the existing nomenclature and that it enhances awareness, understanding of the disease and drug/biomarker development.

The representative, robust, patient-centric Delphi process systematically addressed all the issues and views over the past years and through consensus has arrived at both a refined definition and a new name.

The new nomenclature strives to accelerate disease awareness whilst minimising stigma associated with the use of terms perceived as stigmatising by some patients and their caregivers by the inclusion of patient advocacy groups, the group noted.

Several critical findings emerged from the nomenclature consensus process; the use of an overarching term which could accommodate the evolution of disease understanding, there was clear support for a name change, and the use of a metabolic descriptor in the new nomenclature.

"We believe this process, which has multi-stakeholder endorsement, provides a strong platform from which we can raise disease awareness, reduce stigma and accelerate drug and biomarker development for the benefit of patients with MASH, MASLD, and MetALD," the team concluded.However, there has been an ongoing debate on the usefulness of the NAFLD name change.

According to new nomenclature-

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.

Nonalcoholic fatty liver disease (NAFLD) will now be metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD encompasses patients who have hepatic steatosis and have at least one of five cardiometabolic risk factors.

A new category, outside pure MASLD, termed MetALD (pronunciation: Met A-L-D) was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 g/week and 210 g/week for females and males respectively).

Metabolic dysfunction-associated steatohepatitis (MASH) is the replacement term for NASH.

Those with no metabolic parameters and no known cause have cryptogenic SLD.

The multisociety experts feel that new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.

Reference:

Rinella, Mary E.1; Lazarus, Jeffrey V.2,3; Ratziu, Vlad4; Francque, Sven M.5,6; Sanyal, Arun J.7; Kanwal, Fasiha8,9; Romero, Diana2; Abdelmalek, Manal F.10; Anstee, Quentin M.11,12; Arab, Juan Pablo13,14,15; Arrese, Marco15,16; Bataller, Ramon17; Beuers, Ulrich18; Boursier, Jerome19; Bugianesi, Elisabetta20; Byrne, Christopher21,22; Castro Narro, Graciela E.16,23,24; Chowdhury, Abhijit25; Cortez-Pinto, Helena26; Cryer, Donna27; Cusi, Kenneth28; El-Kassas, Mohamed29; Klein, Samuel30; Eskridge, Wayne31; Fan, Jiangao32; Gawrieh, Samer33; Guy, Cynthia D.34; Harrison, Stephen A.35; Kim, Seung Up36; Koot, Bart37; Korenjak, Marko38; Kowdley, Kris39; Lacaille, Florence40; Loomba, Rohit41; Mitchell-Thain, Robert42; Morgan, Timothy R.43,44; Powell, Elisabeth45,46,47; Roden, Michael48,49,50; Romero-Gómez, Manuel51; Silva, Marcelo52; Singh, Shivaram Prasad53; Sookoian, Silvia C.15,54,55; Spearman, C. Wendy56; Tiniakos, Dina11,57; Valenti, Luca58,59; Vos, Miriam B.60; Wong, Vincent Wai-Sun61; Xanthakos, Stavra62; Yilmaz, Yusuf63; Younossi, Zobair64; Hobbs, Ansley2; Villota-Rivas, Marcela65; Newsome, Philip N66,67; on behalf of the NAFLD Nomenclature consensus group. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology ():10.1097/HEP.0000000000000520, June 24, 2023. | DOI: 10.1097/HEP.0000000000000520

metabolic dysfunction-associated steatotic liver diseasenon-alcoholic fatty liver diseaseHepatology journalmetabolic dysfunctionNAFLD

Source : Hepatology journal

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751