Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVA.
Department of MedicineCenter for Liver DiseasesInova Fairfax HospitalFalls ChurchVA.
Hepatology. 2021 Mar;73(3):1194-1198. doi: 10.1002/hep.31420. Epub 2021 Feb 6.
Despite the substantial gains in our understanding of NAFLD/NASH over the past 2 decades, there has been some dissatisfaction with the terminology "non-alcoholic" which overemphasizes "alcohol" and underemphasizes the root cause of this liver disease, namely, the predisposing metabolic risk factors. As a potential remedy, a name change from NAFLD to metabolic associated fatty liver disease (MAFLD) has been proposed. Although MAFLD reflects the relevant risk factors for this liver disease, this term is still suboptimal, leaving a great deal of ambiguity. Here, we caution that changing the name without understanding its broad implications can have a negative impact on the field. In this context, changing the terminology without new understanding of the molecular basis of the disease entity, new insights in risk stratification or other important aspect of this liver disease, can create unnecessary confusion which could negatively impact the field. At a time when the field is facing substantial challenges around disease awareness as well as clarity of acceptable endpoints for drug development and biomarker discovery, changing the terminology from one suboptimal name to another suboptimal name without full assessment is expected to deepen these challenges. In the context of this debate about terminology, we recommend the creation of a true international consensus group to include all the relevant scientific liver societies (AASLD, EASL, ALEH, APASL), patient advocacy organizations, bio-pharmaceutical industry, regulatory agencies and policy makers. A consensus meeting must assess the impact and consequences of changing the terminology based on the available evidence and make recommendations that will move the field forward. By this approach, a true collaborative international and inclusive consensus can be adopted by all stakeholders dealing with this important global liver disease.
尽管在过去的 20 年中，我们对非酒精性脂肪性肝病/非酒精性脂肪性肝炎（NAFLD/NASH）的理解有了很大的提高，但对术语“非酒精性”的不满情绪一直存在，因为这个术语过于强调“酒精”，而对这种肝病的根本原因——即潜在的代谢危险因素——强调不足。作为一种潜在的补救措施，有人提议将 NAFLD 更改为代谢相关性脂肪性肝病（MAFLD）。虽然 MAFLD 反映了这种肝病的相关危险因素，但这个术语仍然不太理想，存在很大的模糊性。在这里，我们警告说，如果不了解其广泛含义就更改名称，可能会对该领域产生负面影响。在这种情况下，如果不了解疾病实体的分子基础、风险分层的新见解或这种肝病的其他重要方面，就更改术语，可能会造成不必要的混淆，从而对该领域产生负面影响。在该领域面临疾病意识方面的巨大挑战以及药物开发和生物标志物发现可接受终点的明确性的情况下，在没有全面评估的情况下，将术语从一个不太理想的名称更改为另一个不太理想的名称，预计会加深这些挑战。在这场关于术语的争论中，我们建议创建一个真正的国际共识小组，其中包括所有相关的科学肝脏学会（AASLD、EASL、ALEH、APASL）、患者倡导组织、生物制药行业、监管机构和政策制定者。共识会议必须根据现有证据评估更改术语的影响和后果，并提出将该领域向前推进的建议。通过这种方法，所有处理这种重要全球肝病的利益相关者都可以采用真正的合作性国际和包容性共识。
