Valenzuela-Vallejo Laura, Mantzoros Christos S
Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
Department of Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States; Department of Medicine, Boston VA Healthcare System, Boston, MA 02130, United States.
Metabolism. 2022 Sep;134:155246. doi: 10.1016/j.metabol.2022.155246. Epub 2022 Jul 1.
Non-alcoholic fatty liver disease (NAFLD) is a definition of a prevalent condition that has been given a name describing what the disease is not, mainly due to gaps in the physiopathological understanding of NAFLD when the name was given to it. NAFLD still remains an unmet clinical need to a large extent due to the heterogenicity of the disease and the lack of a more accurate physiology-based classification. In essence, fatty liver disease (FLD) has a multifactorial etiology, including metabolic abnormalities, environmental influences, genetic disorders, and/or their overlap which makes it difficult to diagnose, design appropriate trials for it and treat this disease. Therefore, we propose herein that as our knowledge about this disease continues to grow exponentially, it is time to consider ending this unspecific, negative and broad classification of NAFLD, and turn it into a positive and targeted one describing what the disease is and not what it is not. Thus, we propose the novel FLD "Mantzoros classification". This innovative classification proposes to classify the heterogeneous causes of FLD under one umbrella and eventually lead to a better nomenclature and classification system reflecting pathophysiology. This in turn could lead to both better clinical trials and more personalized care. An additional aim is to generate a dialogue among the experts in this field to eventually reach the right nomenclature for an appropriate disease classification that would facilitate our understanding, approach, diagnosis, and management of this epidemic of FLD. Overall, a novel classification, based on phenotypic manifestations, leading risk factors and probable causes of FLD, could help our understanding and clinically would be accurately defining and differentiating the disease, leading to a more accurate design and execution of clinical trials. This would in turn lead to tangible benefits for all patients suffering from FLD through targeted and more effective personalized treatments.
非酒精性脂肪性肝病（NAFLD）是一种普遍存在的疾病的定义，其名称描述的是该疾病不是什么，这主要是因为在赋予该疾病名称时，对其生理病理学的理解存在差距。由于该疾病的异质性以及缺乏更准确的基于生理学的分类，NAFLD在很大程度上仍然是未满足的临床需求。本质上，脂肪性肝病（FLD）具有多因素病因，包括代谢异常、环境影响、遗传疾病和/或它们的重叠，这使得难以对其进行诊断、设计合适的试验并治疗该疾病。因此，我们在此提议，随着我们对这种疾病的认识继续呈指数级增长，是时候考虑结束对NAFLD这种不具体、消极且宽泛的分类，将其转变为一种积极且有针对性的分类，描述该疾病是什么而不是不是什么。因此，我们提出了新颖的FLD“曼佐罗斯分类法”。这种创新分类法提议将FLD的异质病因归为一类，最终形成一个更好的命名法和分类系统，以反映病理生理学。这反过来可能会带来更好的临床试验和更个性化的护理。另一个目标是在该领域的专家之间引发对话，最终为合适的疾病分类达成正确的命名法，这将有助于我们对这种FLD流行病的理解、处理、诊断和管理。总体而言，一种基于FLD的表型表现、主要危险因素和可能病因的新颖分类法，有助于我们的理解，并且在临床上能够准确地定义和区分该疾病，从而实现更准确的临床试验设计和实施。这反过来将通过有针对性且更有效的个性化治疗，为所有患有FLD的患者带来切实的益处。
