University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA; Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain.
Ann Hepatol. 2024 Jan-Feb;29(1):101133. doi: 10.1016/j.aohep.2023.101133. Epub 2023 Jun 24.
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.
非酒精性脂肪性肝病和非酒精性脂肪性肝炎这两个术语的主要局限性在于依赖排除混杂因素术语和使用可能带有污名化的语言。本研究旨在确定内容专家和患者权益倡导者是否赞成改变命名法和/或定义。一个改良的德尔菲法由三个大型跨国肝脏协会牵头。共识被定义为一个超级多数(67%)的投票。一个独立的、外部于命名法过程的专家委员会对缩写词及其诊断标准做出最终建议。共有来自 56 个国家的 236 名小组成员参加了 4 次在线调查和 2 次混合会议。在四轮调查中,回复率分别为 87%、83%、83%和 78%。74%的受访者认为当前的命名法存在严重缺陷,需要考虑更改名称。“非酒精性”和“脂肪性”这两个术语分别被 61%和 66%的受访者认为带有污名。脂肪性肝病被选为一个涵盖各种脂肪变性病因的总称。脂肪性肝炎被认为是一个重要的病理生理概念,应该保留。取代非酒精性脂肪性肝病的名称是代谢功能障碍相关脂肪性肝病。改变定义包括存在至少 5 种心血管代谢风险因素之一的共识。那些没有代谢参数且无已知病因的人被认为患有隐匿性脂肪性肝病。选择了一个新的类别,称为代谢和酒精相关/相关肝病(MetALD),它位于单纯代谢功能障碍相关脂肪性肝病之外,用于描述那些患有代谢功能障碍相关脂肪性肝病且每周饮酒量超过一定量的人(女性每周 140-350 克,男性每周 210-420 克)。新的命名法和诊断标准得到了广泛的支持,没有污名化,这可以提高认识和患者识别。