A multisociety Delphi consensus statement on new fatty liver disease nomenclature

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.

Young Adult Physical Activity Trajectories and Midlife Nonalcoholic Fatty Liver Disease

“…While it is unknown whether participants had NAFLD at baseline, CARDIA began in 1985 to 1986 before the rapid rise in obesity and diabetes prevalence when participants were at a mean age of 25 years, thus with a likely low overall prevalence of NAFLD at baseline. Additionally, we acknowledge the recent nomenclature shift from NAFLD to metabolic dysfunction–associated steatotic liver disease (MASLD) . Although we used NAFLD criteria in our study, we believe that most of our participants would meet criteria for MASLD …”

Machine Learning Enables Single-Score Assessment of MASLD Presence and Severity

“…For participants who had PDFF measurements available, we defined MASLD cases using PDFF ≥ 5% in addition to at least one of five cardiometabolic criteria. 12 For participants without PDFF measurements, we defined MASLD cases using ICD-10 codes K75.8 and/or K76.0 in addition to at least one of five cardiometabolic criteria. We defined participants (n = 48) had an ICD-10-based diagnosis but a PDFF < 5% as MASLD cases to account for temporal variations in steatosis.…”

Metabolic dysfunction‐associated steatotic liver disease in older adults is associated with frailty and social disadvantage

“…Subsequently, those with a FLI ≥60 were only included if they had a cardiometabolic comorbidity as required for the MASLD definition. 22 Individuals with a FLI of <30 were considered a no-MASLD comparator irrespective of cardiometabolic comorbidity, medication use or alcohol consumption (see Figure 1).…”

“…Because of the link between dysmetabolism and steatotic liver disease, a recent Delphi process involving key stakeholders globally led to a new nomenclature for the condition historically known as NAFLD. 22 Metabolic dysfunction-associated steatotic liver disease (MASLD) has been defined similarly to NAFLD (≥5% of hepatocytes containing fat in the absence of secondary causes of steatosis) but with the addition of requiring the individual with hepatic steatosis to also meet at least one cardiometabolic criterion. 22 The threshold to meet these criteria is relatively low by design, with the goal of capturing most cases previously defined as NAFLD in the new MASLD definition while still highlighting the pathophysiological link between cardiometabolic disease and steatotic liver disease.…”

“…22 Metabolic dysfunction-associated steatotic liver disease (MASLD) has been defined similarly to NAFLD (≥5% of hepatocytes containing fat in the absence of secondary causes of steatosis) but with the addition of requiring the individual with hepatic steatosis to also meet at least one cardiometabolic criterion. 22 The threshold to meet these criteria is relatively low by design, with the goal of capturing most cases previously defined as NAFLD in the new MASLD definition while still highlighting the pathophysiological link between cardiometabolic disease and steatotic liver disease. Though it is assumed that almost all individuals previously categorised as NAFLD would be re-categorised as MASLD, and some preliminary data support this, 23 the impact of this re-definition on prevalence and outcomes is not yet completely known.…”