MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease
Section snippets
Methods
Following discussions, an initial concept sheet was circulated to the panel of contributors. This revealed widespread agreement and consensus that it was time to revisit the nomenclature of metabolic fatty liver disease as a critical initial step for improved patient subphenotyping, clinical trials design, and ultimately, for personalization of medicine.
Subsequently, a manuscript was drafted, circulated to the panel, and feedback incorporated over several rounds of revision. To reach consensus
Impact on the Performance of Noninvasive Assessment of Fibrosis
Noninvasive fibrosis scores are commonly used to identify or exclude significant or advanced fibrosis in patients with fatty liver disease. However, a recent study suggested that the performance of scores such as the NAFLD fibrosis score and fibrosis 4 may vary across the life span, with lower specificity among older adults and lower accuracy in young adults.190 The performance of noninvasive scores and the used Transient Elastography liver stiffness cutoffs in different ethnic populations and
Is NAFLD the Right Name for Metabolic Liver Disease?
How do the preceding considerations influence our thinking on the need to revise the definition and nomenclature for NAFLD? It is clearly the time to do this. The suggestion of this consensus focuses on 4 aspects.
First, NAFLD was described as a condition of “exclusion,” which means that it exists only when other conditions, such as viral hepatitis B and C, autoimmune diseases, or alcohol intake above a particular threshold, are absent. However, with advancements in our understanding of the
Conclusion
The outdated NAFLD/NASH acronyms, the criteria for diagnosis, and a lack of adequate consideration of heterogeneity in risk profiles and treatment responsiveness represent barriers that hamper progress toward effective treatments. The consensus group has suggested an acronym (MAFLD) that we believe more accurately reflects current knowledge of fatty liver diseases associated with metabolic dysfunction that should replace NAFLD/NASH. In addition, we have identified gaps in current knowledge and
Acknowledgments
Members of the International Consensus Panel:
Arun Sanyal, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Brent Neuschwander-Tetri, Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, Missouri.
Claudio Tiribelli, Liver Center, Italian Liver Foundation, Trieste, Italy.
David E. Kleiner, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
Elizabeth Brunt, Department of Pathology and Immunology
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Conflicts of interest The authors disclose the following: Rajiv Jalan, on the international consensus panel, has research collaborations with Takeda and Yaqrit, and consults for Akaza and Yaqrit. Rajiv Jalan is the founder of Yaqrit Limited, which is developing UCL inventions for treatment of patients with cirrhosis. Rajiv Jalan is an inventor of ornithine phenylacetate, which was licensed by UCL to Mallinckrodt. He is also the inventor of Yaq-001, DIALIVE, and Yaq-005, the patents for which have been licensed by his university into a UCL spinout company, Yaqrit Ltd. The rest of authors declare no competing interests for this manuscript. The remaining authors disclose no conflicts.
Funding Mohammed Eslam and Jacob George are supported by the Robert W. Storr Bequest to the Sydney Medical Foundation, University of Sydney; a National Health and Medical Research Council of Australia (NHMRC) Program Grant (APP1053206, APP1149976); and Project Grants (APP1107178 and APP1108422). Philip N. Newsome, on the international consensus panel, is funded and supported by the National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or the NHS.