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1. A multisociety Delphi consensus statement on new fatty liver disease nomenclature

Author

Rinella, Mary E, Lazarus, Jeffrey V, Ratziu, Vlad, Francque, Sven M, Sanyal, Arun J, Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal F, Anstee, Quentin M, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher D, Narro, Graciela E Castro, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna R, Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D, Harrison, Stephen A, Kim, Seung Up, Koot, Bart G, Korenjak, Marko, Kowdley, Kris V, Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R, Powell, Elisabeth E, Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C, Spearman, C Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B, Wong, Vincent Wai-Sun, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Newsome, Philip N, and group, NAFLD Nomenclature consensus

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Digestive Diseases, Clinical Research, Hepatitis, Chronic Liver Disease and Cirrhosis, Substance Misuse, Oral and gastrointestinal, Good Health and Well Being, Female, Male, Humans, Non-alcoholic Fatty Liver Disease, Delphi Technique, Ethanol, Consensus, Hepatomegaly, NAFLD Nomenclature consensus group, ALD, Delphi, MASH, MASLD, Met-ALD, NAFLD, alcohol, metabolic, nomenclature, stigma, Public Health and Health Services, Gastroenterology & Hepatology, Clinical sciences
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 favour 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 panellists 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 (MASLD). 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 non-stigmatising, and can improve awareness and patient identification.

Published
2023

2. A multisociety Delphi consensus statement on new fatty liver disease nomenclature.

Author

Rinella, Mary, Lazarus, Jeffrey, Ratziu, Vlad, Francque, Sven, Sanyal, Arun, Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal, Anstee, Quentin, Arab, Juan, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher, Castro Narro, Graciela, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna, Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia, Harrison, Stephen, Kim, Seung, Koot, Bart, Korenjak, Marko, Kowdley, Kris, Lacaille, Florence, Powell, Elisabeth, Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram, Sookoian, Silvia, Spearman, C, Tiniakos, Dina, Valenti, Luca, Vos, Miriam, Wong, Vincent, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Newsome, Philip, Mitchell-Thain, Robert, Morgan, Timothy, and Loomba, Rohit

Subjects
Male, Female, Humans, Non-alcoholic Fatty Liver Disease, Delphi Technique, Hepatomegaly, Surveys and Questionnaires
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.

Published
2023

3. Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease

Author

Younossi, Zobair M, AlQahtani, Saleh A, Alswat, Khalid, Yilmaz, Yusuf, Keklikkiran, Caglayan, Funuyet-Salas, Jesús, Romero-Gómez, Manuel, Fan, Jian-Gao, Zheng, Ming-Hua, El-Kassas, Mohamed, Castera, Laurent, Liu, Chun-Jen, Wong, Vincent Wai-Sun, Zelber-Sagi, Shira, Allen, Alina M, Lam, Brian, Treeprasertsuk, Sombat, Hameed, Saeed, Takahashi, Hirokazu, Kawaguchi, Takumi, Schattenberg, Jörn M, Duseja, Ajay, Newsome, Phil, Francque, Sven, Spearman, C Wendy, Fernández, Marlen I Castellanos, Burra, Patrizia, Roberts, Stuart K, Chan, Wah-Kheong, Arrese, Marco, Silva, Marcelo, Rinella, Mary, Singal, Ashwani K, Gordon, Stuart, Fuchs, Michael, Alkhouri, Naim, Cusi, Kenneth, Loomba, Rohit, Ranagan, Jane, Eskridge, Wayne, Kautz, Achim, Ong, Janus P, Kugelmas, Marcelo, Eguchi, Yuichiro, Diago, Moises, Yu, Ming-Lung, Gerber, Lynn, Fornaresio, Lisa, Nader, Fatema, Henry, Linda, Racila, Andrei, Golabi, Pegah, Stepanova, Maria, Carrieri, Patrizia, Lazarus, Jeffrey V, and Council, the Global NASH

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Digestive Diseases, Chronic Liver Disease and Cirrhosis, Hepatitis, Health Services, Clinical Research, Prevention, Good Health and Well Being, Global NASH Council, MASH, MASLD, SLD, communication, discrimination, fatty liver, metabolic, patient-reported outcomes, Public Health and Health Services, Gastroenterology & Hepatology, Clinical sciences
Abstract

Background & aimsPatients with fatty liver disease may experience stigma from the disease or comorbidities. In this cross-sectional study, we aimed to understand stigma among patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) and healthcare providers.MethodsMembers of the Global NASH Council created two surveys about experiences/attitudes toward NAFLD and related diagnostic terms: a 68-item patient and a 41-item provider survey.ResultsSurveys were completed by 1,976 patients with NAFLD across 23 countries (51% Middle East/North Africa [MENA], 19% Europe, 17% USA, 8% Southeast Asia, 5% South Asia) and 825 healthcare providers (67% gastroenterologists/hepatologists) across 25 countries (39% MENA, 28% Southeast Asia, 22% USA, 6% South Asia, 3% Europe). Of all patients, 48% ever disclosed having NAFLD/NASH to family/friends; the most commonly used term was "fatty liver" (88% at least sometimes); "metabolic disease" or "MAFLD" were rarely used (never by >84%). Regarding various perceptions of diagnostic terms by patients, there were no substantial differences between "NAFLD", "fatty liver disease (FLD)", "NASH", or "MAFLD". The most popular response was being neither comfortable nor uncomfortable with either term (56%-71%), with slightly greater discomfort with "FLD" among the US and South Asian patients (47-52% uncomfortable). Although 26% of patients reported stigma related to overweight/obesity, only 8% reported a history of stigmatization or discrimination due to NAFLD. Among providers, 38% believed that the term "fatty" was stigmatizing, while 34% believed that "nonalcoholic" was stigmatizing, more commonly in MENA (43%); 42% providers (gastroenterologists/hepatologists 45% vs. 37% other specialties, p = 0.03) believed that the name change to metabolic dysfunction-associated steatotic liver disease (or MASLD) might reduce stigma. Regarding the new nomenclature, the percentage of providers reporting "steatotic liver disease" as stigmatizing was low (14%).ConclusionsThe perception of NAFLD stigma varies among patients, providers, geographic locations and sub-specialties.Impact and implicationsOver the past decades, efforts have been made to change the nomenclature of nonalcoholic fatty liver disease (NAFLD) to better align with its underlying pathogenetic pathways and remove any potential stigma associated with the name. Given the paucity of data related to stigma in NAFLD, we undertook this global comprehensive survey to assess stigma in NAFLD among patients and providers from around the world. We found there is a disconnect between physicians and patients related to stigma and related nomenclature. With this knowledge, educational programs can be developed to better target stigma in NAFLD among all stakeholders and to provide a better opportunity for the new nomenclature to address the issues of stigma.

Published
2023

4. THU-453 Stigma in NAFLD and NASH: a global survey of patients and providers

Author

Younossi, Zobair, Yılmaz, Yusuf, Fan, Jian-Gao, Wong, Vincent Wai-Sun, Kassas, Mohamed El, Zelber-Sagi, Shira, Allen, Alina, Rinella, Mary, Singal, Ashwani, Gordon, Stuart C, Fuchs, Michael, Eskridge, Wayne, Alkhouri, Naim, Alswat, Khalid, Takahashi, Hirokazu, Kawaguchi, Takumi, Ranagan, Jane, Zheng, Ming-Hua, Duseja, Ajay Kumar, Burra, Patrizia, Patrizia, Carrieri, Arrese, Marco, Kautz, Achim, Ong, Janus, Castera, Laurent, Francque, Sven, Kugelmas, Marcelo, Eguchi, Yuichiro, Treeprasertsuk, Sombat, Fernández, Marlen Ivon Castellanos, Gomez, Manuel Romero, Newsome, Philip N, Cusi, Kenneth, Loomba, Rohit, Schattenberg, Jörn, Yu, Ming-Lung, Diago, Moises, Gerber, Lynn, Lam, Brian, Fornaresio, Lisa, Nader, Fatema, Henry, Linda, Racila, Andrei, Golabi, Pegah, Stepanova, Maria, Alqahtani, Saleh, and Lazarus, Jeffrey

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Public Health and Health Services, Gastroenterology & Hepatology, Clinical sciences
Published
2023

5. Real-world evidence on non-invasive tests and associated cut-offs used to assess fibrosis in routine clinical practice

Author

Lazarus, Jeffrey V, Castera, Laurent, Mark, Henry E, Allen, Alina M, Adams, Leon A, Anstee, Quentin M, Arrese, Marco, Alqahtani, Saleh A, Bugianesi, Elisabetta, Colombo, Massimo, Cusi, Kenneth, Hagström, Hannes, Loomba, Rohit, Romero-Gómez, Manuel, Schattenberg, Jörn M, Thiele, Maja, Valenti, Luca, Wong, Vincent Wai-Sun, Yilmaz, Yusuf, Younossi, Zobair M, Francque, Sven M, and Tsochatzis, Emmanuel A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Chronic Liver Disease and Cirrhosis, Liver Disease, Digestive Diseases, Good Health and Well Being, Hepatology, NAFLD, NITs, FIB-4, Elastography, NFS, FIB-4, Fibrosis-4, NAFLD, Non-alcoholic fatty liver disease, NFS, NAFLD fibrosis score, NIT, Non-invasive test, Clinical sciences
Abstract

Background & aimsNon-invasive tests (NITs) offer a practical solution for advanced fibrosis identification in non-alcoholic fatty liver disease (NAFLD). Despite increasing implementation, their use is not standardised, which can lead to inconsistent interpretation and risk stratification. We aimed to assess the types of NITs and the corresponding cut-offs used in a range of healthcare settings.MethodsA survey was distributed to a convenience sample of liver health experts who participated in a global NAFLD consensus statement. Respondents provided information on the NITs used in their clinic with the corresponding cut-offs and those used in established care pathways in their areas.ResultsThere were 35 respondents from 24 countries, 89% of whom practised in tertiary level settings. A total of 14 different NITs were used, and each respondent reported using at least one (median = 3). Of the respondents, 80% reported using FIB-4 and liver stiffness by vibration-controlled transient elastography (Fibroscan®), followed by the NAFLD fibrosis score (49%). For FIB-4, 71% of respondents used a low cut-off of 7.5 to >20 kPa, respectively).ConclusionsThe cut-offs used for the same NITs for NAFLD risk stratification vary between clinicians. As cut-offs impact test performance, these findings underscore the heterogeneity in risk-assessment and support the importance of establishing consistent guidelines on the standardised use of NITs in NAFLD management.Lay summaryOwing to the high prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population it is important to identify those who have more advanced stages of liver fibrosis, so that they can be properly treated. Non-invasive tests (NITs) provide a practical way to assess fibrosis risk in patients. However, we found that the cut-offs used for the same NITs vary between clinicians. As cut-offs impact test performance, these findings highlight the importance of establishing consistent guidelines on the standardised use of NITs to optimise clinical management of NAFLD.

Published
2023

6. Metabolic subtypes of patients with NAFLD exhibit distinctive cardiovascular risk profiles

Author

Martínez‐Arranz, Ibon, Bruzzone, Chiara, Noureddin, Mazen, Gil‐Redondo, Ruben, Mincholé, Itziar, Bizkarguenaga, Maider, Arretxe, Enara, Iruarrizaga‐Lejarreta, Marta, Fernández‐Ramos, David, Lopitz‐Otsoa, Fernando, Mayo, Rebeca, Embade, Nieves, Newberry, Elizabeth, Mittendorf, Bettina, Izquierdo‐Sánchez, Laura, Smid, Vaclav, Arnold, Jorge, Iruzubieta, Paula, Castaño, Ylenia Pérez, Krawczyk, Marcin, Marigorta, Urko M, Morrison, Martine C, Kleemann, Robert, Martín‐Duce, Antonio, Hayardeny, Liat, Vitek, Libor, Bruha, Radan, de la Fuente, Rocío Aller, Crespo, Javier, Romero‐Gomez, Manuel, Banales, Jesus M, Arrese, Marco, Cusi, Kenneth, Bugianesi, Elisabetta, Klein, Samuel, Lu, Shelly C, Anstee, Quentin M, Millet, Oscar, Davidson, Nicholas O, Alonso, Cristina, and Mato, José M

Subjects
Medical Biochemistry and Metabolomics, Biomedical and Clinical Sciences, Heart Disease, Cardiovascular, Chronic Liver Disease and Cirrhosis, Digestive Diseases, Genetics, Liver Disease, Atherosclerosis, Clinical Research, Aetiology, 2.1 Biological and endogenous factors, Good Health and Well Being, Animals, Apolipoproteins B, Cardiovascular Diseases, Cholesterol, VLDL, Heart Disease Risk Factors, Lipoproteins, VLDL, Liver, Mice, Non-alcoholic Fatty Liver Disease, Phospholipases, Risk Factors, Triglycerides, Clinical Sciences, Immunology, Gastroenterology & Hepatology, Clinical sciences
Abstract

Background and aimsWe previously identified subsets of patients with NAFLD with different metabolic phenotypes. Here we align metabolomic signatures with cardiovascular disease (CVD) and genetic risk factors.Approach and resultsWe analyzed serum metabolome from 1154 individuals with biopsy-proven NAFLD, and from four mouse models of NAFLD with impaired VLDL-triglyceride (TG) secretion, and one with normal VLDL-TG secretion. We identified three metabolic subtypes: A (47%), B (27%), and C (26%). Subtype A phenocopied the metabolome of mice with impaired VLDL-TG secretion; subtype C phenocopied the metabolome of mice with normal VLDL-TG; and subtype B showed an intermediate signature. The percent of patients with NASH and fibrosis was comparable among subtypes, although subtypes B and C exhibited higher liver enzymes. Serum VLDL-TG levels and secretion rate were lower among subtype A compared with subtypes B and C. Subtype A VLDL-TG and VLDL-apolipoprotein B concentrations were independent of steatosis, whereas subtypes B and C showed an association with these parameters. Serum TG, cholesterol, VLDL, small dense LDL5,6 , and remnant lipoprotein cholesterol were lower among subtype A compared with subtypes B and C. The 10-year high risk of CVD, measured with the Framingham risk score, and the frequency of patatin-like phospholipase domain-containing protein 3 NAFLD risk allele were lower in subtype A.ConclusionsMetabolomic signatures identify three NAFLD subgroups, independent of histological disease severity. These signatures align with known CVD and genetic risk factors, with subtype A exhibiting a lower CVD risk profile. This may account for the variation in hepatic versus cardiovascular outcomes, offering clinically relevant risk stratification.

Published
2022

8. The impact of stigma on quality of life and liver disease burden among patients with nonalcoholic fatty liver disease

Author

Younossi, Zobair M., AlQahtani, Saleh A., Funuyet-Salas, Jesús, Romero-Gómez, Manuel, Yilmaz, Yusuf, Keklikkiran, Caglayan, Alswat, Khalid, Yu, Ming-Lung, Liu, Chun-Jen, Fan, Jian-Gao, Zheng, Ming-Hua, Burra, Patrizia, Francque, Sven M., Castera, Laurent, Schattenberg, Jörn M., Newsome, Philip N., Allen, Alina M., El-Kassas, Mohamed, Treeprasertsuk, Sombat, Hameed, Saeed, Wai-Sun Wong, Vincent, Zelber-Sagi, Shira, Takahashi, Hirokazu, Kawaguchi, Takumi, Castellanos Fernández, Marlen I., Duseja, Ajay, Arrese, Marco, Rinella, Mary, Singal, Ashwani K., Gordon, Stuart C., Fuchs, Michael, Eskridge, Wayne, Alkhouri, Naim, Cusi, Kenneth, Loomba, Rohit, Ranagan, Jane, Kautz, Achim, Ong, Janus P., Kugelmas, Marcelo, Eguchi, Yuichiro, Diago, Moises, Gerber, Lynn, Lam, Brian, Fornaresio, Lisa, Nader, Fatema, Spearman, C. Wendy, Roberts, Stuart K., Chan, Wah-Kheong, Silva, Marcelo, Racila, Andrei, Golabi, Pegah, Ananchuensook, Prooksa, Henry, Linda, Stepanova, Maria, Carrieri, Patrizia, and Lazarus, Jeffrey V.

Published
2024
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10. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease

Author

Kanwal, Fasiha, Shubrook, Jay H, Adams, Leon A, Pfotenhauer, Kim, Wai-Sun Wong, Vincent, Wright, Eugene, Abdelmalek, Manal F, Harrison, Stephen A, Loomba, Rohit, Mantzoros, Christos S, Bugianesi, Elisabetta, Eckel, Robert H, Kaplan, Lee M, El-Serag, Hashem B, and Cusi, Kenneth

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Nutrition and Dietetics, Chronic Liver Disease and Cirrhosis, Clinical Research, Digestive Diseases, Prevention, Hepatitis, Health Services, Liver Disease, 4.1 Discovery and preclinical testing of markers and technologies, 4.2 Evaluation of markers and technologies, 7.3 Management and decision making, Oral and gastrointestinal, Cardiovascular, Good Health and Well Being, Clinical Decision-Making, Consensus, Critical Pathways, Decision Support Techniques, Evidence-Based Medicine, Gastroenterology, Humans, Non-alcoholic Fatty Liver Disease, Predictive Value of Tests, Risk Assessment, Risk Factors, Treatment Outcome, Nonalcoholic Fatty Liver Disease, NAFLD, Nonalcoholic Steatohepatitis, NASH, Clinical Care Pathway, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics
Abstract

Find AGA's NASH Clinical Care Pathway App for iOS and Android mobile devices at nash.gastro.org. Scan this QR code to be taken directly to the website.Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common, currently affecting approximately 37% of US adults. NAFLD is most often managed in primary care or endocrine clinics, where clinicians must determine which patients might benefit from secondary care to address hepatic manifestations, comorbid metabolic traits, and cardiovascular risks of the disease. Because NAFLD is largely asymptomatic, and because optimal timing of treatment depends on accurate staging of fibrosis risk, screening at the primary care level is critical, together with consistent, timely, evidence-based, widely accessible, and testable management processes. To achieve these goals, the American Gastroenterological Association assembled a multidisciplinary panel of experts to develop a Clinical Care Pathway providing explicit guidance on the screening, diagnosis, and treatment of NAFLD. This article describes the NAFLD Clinical Care Pathway they developed and provides a rationale supporting proposed steps to assist clinicians in diagnosing and managing NAFLD with clinically significant fibrosis (stage F2-F4) based on the best available evidence. This Pathway is intended to be applicable in any setting where care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices.

Published
2021

11. A multisociety Delphi consensus statement on new fatty liver disease nomenclature

Author

Rinella, Mary E., Lazarus, Jeffrey V., Ratziu, Vlad, Francque, Sven M., Sanyal, Arun J., Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal F., Anstee, Quentin M., Arab, Juan Pablo, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher D., Narro, Graciela E. Castro, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna R., Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D., Harrison, Stephen A., Kim, Seung Up, Koot, Bart G., Korenjak, Marko, Kowdley, Kris V., Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R., Powell, Elisabeth E., Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C., Spearman, C. Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B., Wong, Vincent Wai-Sun, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, and Newsome, Philip N.

Published
2024
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12. Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study

Author

Barritt, A Sidney, Watkins, Stephanie, Gitlin, Norman, Klein, Samuel, Lok, Anna S, Loomba, Rohit, Schoen, Cheryl, Reddy, K Rajender, Trinh, Huy Ngoc, Mospan, Andrea R, Vos, Miriam B, Weiss, L Michael, Cusi, Kenneth, Neuschwander‐Tetri, Brent A, and Sanyal, Arun J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Digestive Diseases, Chronic Liver Disease and Cirrhosis, Hepatitis, Clinical Research, Good Health and Well Being, Clinical sciences
Abstract

Much of the current data on nonalcoholic fatty liver disease (NAFLD) are derived from biopsy-based studies that may introduce ascertainment and selection bias. Selection of patients for liver biopsy has implications for clinical practice and the reported epidemiology of NAFLD. The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real-world practice. Adults from TARGET-NASH were included in this study. Descriptive statistics are provided for the cohort and compare the characteristics of histologic NAFLD versus patients with clinically diagnosed NAFLD, followed by logistic regression and machine-learning models to describe predictors of liver biopsy. The records of 3,474 subjects were analyzed; median age was 59 years, 59% were female, 75% were White, and median body mass index was 32 kg/m2. Using histologic and/or clinical criteria, a diagnosis of nonalcoholic steatohepatitis was made in 37%, and cirrhosis in 33%. Comorbid conditions included cardiovascular disease (19%), mental health diagnoses (49%), and osteoarthritis (10%). Predictors of a biopsy diagnosis included White race, female sex, diabetes, and elevated alanine aminotransferase (ALT). ALT increased the odds of liver biopsy by 14% per 10-point rise. Machine-learning analyses showed non-White patients with ALT

Published
2021

13. Validation of a Clinical Risk-based Classification System in a Large Nonalcoholic Fatty Liver Disease Real-world Cohort

Author

Abdelmalek, Manal, Aguilar, Humberto, Ahmed, Aijaz, Allen, Alina, Barlow, Sarah, Barritt, Sid, Bernstein, David, Bhamidimarri, Kaylan, Billings, Liana, Brown, Kyle, Brown, Robert, Corbin, Karen, Cusi, Kenneth, deLemos, Andrew, Emerick, Karan, Firpi-Morell, Roberto, Ghali, Maged Adel, Henry, Zachary, Jackson, Whitney, Janardhan, Sujit, Kabbany, Mohammad, Kemmer, Nyingi, Koch, David, Kupec, Justin, Landis, Charles, Lawrence, Mary Katherine, Levy, Cynthia, Lidofsky, Steven, Lok, Anna, Luketic, Velimir, Martinez, Enrique, McClain, Craig, McKiernan, Patrick, Mitchell, Ellen, Noureddin, Mazen, Palle, Sirish, Pham, Yen, Pound, David, Reddy, Rajender, Regenstein, Fredric, Rinella, Mary, Rochling, Fedja, Rudolph, Bryan, Rustgi, Vinod, Said, Adnan, Samala, Niharika, Sarkar, Souvik, Sherman, Kenneth, Shiffman, Mitchell, Smith, Coleman, Taunk, Jawahar, Tetri, Brent, Thuluvath, Paul, Trinh, Huy, Verna, Elizabeth, Vos, Miriam, Weiss, L. Michael, Wong, Mark, Wyne, Kathleen, Xanthakos, Stavra, Sanyal, Arun J., Munoz, Breda, Barritt, A. Sidney, IV, Muthiah, Mark, Mospan, Andrea R., Reddy, K. Rajender, Thuluvath, Paul J., Bhamidimarri, Kalyan Ram, and Fried, Michael W.

Published
2023
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14. Preparing for the NASH Epidemic: A Call to Action

Author

Kanwal, Fasiha, Shubrook, Jay H., Younossi, Zobair, Natarajan, Yamini, Bugianesi, Elisabetta, Rinella, Mary E., Harrison, Stephen A., Mantzoros, Christos, Pfotenhauer, Kim, Klein, Samuel, Eckel, Robert H., Kruger, Davida, El-Serag, Hashem, and Cusi, Kenneth

Published
2021
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15. Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease

Author

Arab, Juan Pablo, Dirchwolf, Melisa, Álvares-da-Silva, Mário Reis, Barrera, Francisco, Benítez, Carlos, Castellanos-Fernandez, Marlene, Castro-Narro, Graciela, Chavez-Tapia, Norberto, Chiodi, Daniela, Cotrim, Helma, Cusi, Kenneth, de Oliveira, Claudia Pinto Marques Souza, Díaz, Javier, Fassio, Eduardo, Gerona, Solange, Girala, Marcos, Hernandez, Nelia, Marciano, Sebastián, Masson, Walter, Méndez-Sánchez, Nahum, Leite, Nathalie, Lozano, Adelina, Padilla, Martín, Panduro, Arturo, Paraná, Raymundo, Parise, Edison, Perez, Marlene, Poniachik, Jaime, Restrepo, Juan Carlos, Ruf, Andrés, Silva, Marcelo, Tagle, Martín, Tapias, Monica, Torres, Kenia, Vilar-Gomez, Eduardo, Costa Gil, José Eduardo, Gadano, Adrian, and Arrese, Marco

Published
2020
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16. A global action agenda for turning the tide on fatty liver disease

Author

Lazarus, Jeffrey V., Mark, Henry E., Allen, Alina M., Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A., Anstee, Quentin M., Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N., Burra, Patrizia, Castro-Narro, Graciela E., Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M., Gastaldelli, Amalia, Hagström, Hannes, Huang, Terry T.K., Wajcman, Dana Ivancovsky, Kautz, Achim, Kopka, Christopher J., Krag, Aleksander, Newsome, Philip N., Rinella, Mary E., Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C. Wendy, Terrault, Norah A., Tsochatzis, Emmanuel A., Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M., Wong, Vincent Wai Sun, Younossi, Zobair M., Lazarus, Jeffrey V., Mark, Henry E., Allen, Alina M., Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A., Anstee, Quentin M., Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N., Burra, Patrizia, Castro-Narro, Graciela E., Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M., Gastaldelli, Amalia, Hagström, Hannes, Huang, Terry T.K., Wajcman, Dana Ivancovsky, Kautz, Achim, Kopka, Christopher J., Krag, Aleksander, Newsome, Philip N., Rinella, Mary E., Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C. Wendy, Terrault, Norah A., Tsochatzis, Emmanuel A., Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M., Wong, Vincent Wai Sun, and Younossi, Zobair M.

Abstract

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of "agree"responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% "agree"). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce the prevalence of fatty liver disease and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.

Published
2024

17. A global action agenda for turning the tide on fatty liver disease

Author

Lazarus, J, Mark, H, Allen, A, Arab, J, Carrieri, P, Noureddin, M, Alazawi, W, Alkhouri, N, Alqahtani, S, Anstee, Q, Arrese, M, Bataller, R, Berg, T, Brennan, P, Burra, P, Castro-Narro, G, Cortez-Pinto, H, Cusi, K, Dedes, N, Duseja, A, Francque, S, Gastaldelli, A, Hagström, H, Huang, T, Ivancovsky Wajcman, D, Kautz, A, Kopka, C, Krag, A, Newsome, P, Rinella, M, Romero, D, Sarin, S, Silva, M, Spearman, C, Terrault, N, Tsochatzis, E, Valenti, L, Villota-Rivas, M, Zelber-Sagi, S, Schattenberg, J, Wong, V, Younossi, Z, Perseghin, G, Lazarus, Jeffrey V, Mark, Henry E, Allen, Alina M, Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A, Anstee, Quentin M, Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N, Burra, Patrizia, Castro-Narro, Graciela E, Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M, Gastaldelli, Amalia, Hagström, Hannes, Huang, Terry T K, Ivancovsky Wajcman, Dana, Kautz, Achim, Kopka, Christopher J, Krag, Aleksander, Newsome, Philip N, Rinella, Mary E, Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C Wendy, Terrault, Norah A, Tsochatzis, Emmanuel A, Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M, Wong, Vincent Wai-Sun, Younossi, Zobair M, Perseghin, Gianluca, Lazarus, J, Mark, H, Allen, A, Arab, J, Carrieri, P, Noureddin, M, Alazawi, W, Alkhouri, N, Alqahtani, S, Anstee, Q, Arrese, M, Bataller, R, Berg, T, Brennan, P, Burra, P, Castro-Narro, G, Cortez-Pinto, H, Cusi, K, Dedes, N, Duseja, A, Francque, S, Gastaldelli, A, Hagström, H, Huang, T, Ivancovsky Wajcman, D, Kautz, A, Kopka, C, Krag, A, Newsome, P, Rinella, M, Romero, D, Sarin, S, Silva, M, Spearman, C, Terrault, N, Tsochatzis, E, Valenti, L, Villota-Rivas, M, Zelber-Sagi, S, Schattenberg, J, Wong, V, Younossi, Z, Perseghin, G, Lazarus, Jeffrey V, Mark, Henry E, Allen, Alina M, Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A, Anstee, Quentin M, Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N, Burra, Patrizia, Castro-Narro, Graciela E, Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M, Gastaldelli, Amalia, Hagström, Hannes, Huang, Terry T K, Ivancovsky Wajcman, Dana, Kautz, Achim, Kopka, Christopher J, Krag, Aleksander, Newsome, Philip N, Rinella, Mary E, Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C Wendy, Terrault, Norah A, Tsochatzis, Emmanuel A, Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M, Wong, Vincent Wai-Sun, Younossi, Zobair M, and Perseghin, Gianluca

Abstract

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.

Published
2024

18. Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease

Author

Center for Outcomes Research in Liver Diseases (US), Younossi, Zobair M., Alqahtani, Saleh A., Alswat, Khalid, Yilmaz, Yusuf, Keklikkiran, Caglayan, Funuyet-Salas, Jesús, Romero-Gómez, Manuel, Fan, Jian-Gao, Zheng, Ming-Hua, El-Kassas, Mohamed, Castera, Laurent, Liu, Chun-Jen, Wai-Sun Wong, Vincent, Zelber-Sagi, Shira, Allen, Alina M., Lam, Brian, Treeprasertsuk, Sombat, Hameed, Saeed, Takahashi, Hirokazu, Kawaguchi, Takumi, Schattenberg, Jörn M., Duseja, Ajay, Newsome, Phil N., Francque, Sven, Spearman, C. Wendy, Castellanos Fernandez, Marlen Ivon, Burra, Patrizia, Roberts, Stuart K., Chan, Wah-Kheong, Arrese, Marco, Silva, Marcelo, Rinella, Mary, Singal, Ashwani K., Gordon, Stuart, Fuchs, Michael, Alkhouri, Naim, Cusi, Kenneth, Loomba, Rohit, Ranagan, Jane, Eskridge, Wayne, Kautz, Achim, Ong, Janus P., Kugelmas, Marcelo, Eguchi, Yuichiro, Diago, Moises, Yu, Ming-Lung, Gerber, Lynn, Fornaresio, Lisa, Nader, Fatema, Henry, Linda, Racila, Andrei, Golabi, Pegah, Stepanova, Maria, Carrieri, Patrizia, Lazarus, Jeffrey V., Center for Outcomes Research in Liver Diseases (US), Younossi, Zobair M., Alqahtani, Saleh A., Alswat, Khalid, Yilmaz, Yusuf, Keklikkiran, Caglayan, Funuyet-Salas, Jesús, Romero-Gómez, Manuel, Fan, Jian-Gao, Zheng, Ming-Hua, El-Kassas, Mohamed, Castera, Laurent, Liu, Chun-Jen, Wai-Sun Wong, Vincent, Zelber-Sagi, Shira, Allen, Alina M., Lam, Brian, Treeprasertsuk, Sombat, Hameed, Saeed, Takahashi, Hirokazu, Kawaguchi, Takumi, Schattenberg, Jörn M., Duseja, Ajay, Newsome, Phil N., Francque, Sven, Spearman, C. Wendy, Castellanos Fernandez, Marlen Ivon, Burra, Patrizia, Roberts, Stuart K., Chan, Wah-Kheong, Arrese, Marco, Silva, Marcelo, Rinella, Mary, Singal, Ashwani K., Gordon, Stuart, Fuchs, Michael, Alkhouri, Naim, Cusi, Kenneth, Loomba, Rohit, Ranagan, Jane, Eskridge, Wayne, Kautz, Achim, Ong, Janus P., Kugelmas, Marcelo, Eguchi, Yuichiro, Diago, Moises, Yu, Ming-Lung, Gerber, Lynn, Fornaresio, Lisa, Nader, Fatema, Henry, Linda, Racila, Andrei, Golabi, Pegah, Stepanova, Maria, Carrieri, Patrizia, and Lazarus, Jeffrey V.

Abstract

[Background & Aims] Patients with fatty liver disease may experience stigma from the disease or comorbidities. In this cross-sectional study, we aimed to understand stigma among patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) and healthcare providers., [Methods] Members of the Global NASH Council created two surveys about experiences/attitudes toward NAFLD and related diagnostic terms: a 68-item patient and a 41-item provider survey., [Results] Surveys were completed by 1,976 patients with NAFLD across 23 countries (51% Middle East/North Africa [MENA], 19% Europe, 17% USA, 8% Southeast Asia, 5% South Asia) and 825 healthcare providers (67% gastroenterologists/hepatologists) across 25 countries (39% MENA, 28% Southeast Asia, 22% USA, 6% South Asia, 3% Europe). Of all patients, 48% ever disclosed having NAFLD/NASH to family/friends; the most commonly used term was “fatty liver” (88% at least sometimes); “metabolic disease” or “MAFLD” were rarely used (never by >84%). Regarding various perceptions of diagnostic terms by patients, there were no substantial differences between “NAFLD”, “fatty liver disease (FLD)”, “NASH”, or “MAFLD”. The most popular response was being neither comfortable nor uncomfortable with either term (56%-71%), with slightly greater discomfort with “FLD” among the US and South Asian patients (47-52% uncomfortable). Although 26% of patients reported stigma related to overweight/obesity, only 8% reported a history of stigmatization or discrimination due to NAFLD. Among providers, 38% believed that the term “fatty” was stigmatizing, while 34% believed that “nonalcoholic” was stigmatizing, more commonly in MENA (43%); 42% providers (gastroenterologists/hepatologists 45% vs. 37% other specialties, p = 0.03) believed that the name change to metabolic dysfunction-associated steatotic liver disease (or MASLD) might reduce stigma. Regarding the new nomenclature, the percentage of providers reporting “steatotic liver disease” as stigmatizing was low (14%)., [Conclusions] The perception of NAFLD stigma varies among patients, providers, geographic locations and sub-specialties.

Published
2024

26. Validation of a Clinical Risk-based Classification System in a Large Nonalcoholic Fatty Liver Disease Real-world Cohort

Author

Sanyal, Arun J., primary, Munoz, Breda, additional, Cusi, Kenneth, additional, Barritt, A. Sidney, additional, Muthiah, Mark, additional, Mospan, Andrea R., additional, Reddy, K. Rajender, additional, Firpi-Morell, Roberto, additional, Thuluvath, Paul J., additional, Bhamidimarri, Kalyan Ram, additional, Fried, Michael W., additional, Abdelmalek, Manal, additional, Aguilar, Humberto, additional, Ahmed, Aijaz, additional, Allen, Alina, additional, Barlow, Sarah, additional, Barritt, Sid, additional, Bernstein, David, additional, Bhamidimarri, Kaylan, additional, Billings, Liana, additional, Brown, Kyle, additional, Brown, Robert, additional, Corbin, Karen, additional, deLemos, Andrew, additional, Emerick, Karan, additional, Ghali, Maged Adel, additional, Henry, Zachary, additional, Jackson, Whitney, additional, Janardhan, Sujit, additional, Kabbany, Mohammad, additional, Kemmer, Nyingi, additional, Koch, David, additional, Kupec, Justin, additional, Landis, Charles, additional, Lawrence, Mary Katherine, additional, Levy, Cynthia, additional, Lidofsky, Steven, additional, Lok, Anna, additional, Luketic, Velimir, additional, Martinez, Enrique, additional, McClain, Craig, additional, McKiernan, Patrick, additional, Mitchell, Ellen, additional, Noureddin, Mazen, additional, Palle, Sirish, additional, Pham, Yen, additional, Pound, David, additional, Reddy, Rajender, additional, Regenstein, Fredric, additional, Rinella, Mary, additional, Rochling, Fedja, additional, Rudolph, Bryan, additional, Rustgi, Vinod, additional, Said, Adnan, additional, Samala, Niharika, additional, Sarkar, Souvik, additional, Sherman, Kenneth, additional, Shiffman, Mitchell, additional, Smith, Coleman, additional, Taunk, Jawahar, additional, Tetri, Brent, additional, Thuluvath, Paul, additional, Trinh, Huy, additional, Verna, Elizabeth, additional, Vos, Miriam, additional, Weiss, L. Michael, additional, Wong, Mark, additional, Wyne, Kathleen, additional, and Xanthakos, Stavra, additional

Published
2023
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27. THU612 SDHx Pheochromocytoma/Paraganglioma Has Elevation Of Arginine And Lysine Metabolites

Author

Ghayee, Hans Kumar, primary, Richter, Susan, additional, Bechmann, Nicole, additional, Kalavalapalli, Srilaxmi, additional, Joy, Guingab-Cagmat, additional, Xu, Yiling, additional, Cusi, Kenneth, additional, Tischler, Arthur, additional, Powers, James F, additional, Beuschlein, Felix, additional, Robledo, Mercedes, additional, Fliedner, Steffi, additional, Quinkler, Marcus, additional, Fassnacht, Martin, additional, Timmers, Henri, additional, Pacak, Karel, additional, Eisenhofer, Graeme, additional, and Garrett, Timothy J, additional

Published
2023
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31. Summary of Revisions: Standards of Care in Diabetes—2023

Author

ElSayed, Nuha A., Aleppo, Grazia, Aroda, Vanita R., Bannuru, Raveendhara R., Brown, Florence M., Bruemmer, Dennis, Collins, Billy S., Cusi, Kenneth, Das, Sandeep R., Gibbons, Christopher H., Giurini, John M., Hilliard, Marisa E., Isaacs, Diana, Johnson, Eric L., Kahan, Scott, Khunti, Kamlesh, Kosiborod, Mikhail, Leon, Jose, Lyons, Sarah K., Murdock, Lisa, Perry, Mary Lou, Prahalad, Priya, Pratley, Richard E., Seley, Jane Jeffrie, Stanton, Robert C., Sun, Jennifer K., Woodward, Crystal C., Young-Hyman, Deborah, and Gabbay, Robert A.

Subjects
Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Internal Medicine, Summary of Revisions
Published
2022
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32. A multi-society Delphi consensus statement on new fatty liver disease nomenclature

Author

Mary E, R, Jeffrey V, L, Vlad, R, Sven M, F, Arun J, S, Fasiha, K, Diana, R, Manal F, A, Quentin M, A, Juan Pablo, A, Marco, A, Ramon, B, Ulrich, B, Jerome, B, Elisabetta, B, Christopher, B, Graciela E, C, Abhijit, C, Helena, C, Donna, C, Kenneth, C, Mohamed, E, Samuel, K, Wayne, E, Jiangao, F, Samer, G, Cynthia D, G, Stephen A, H, Seung Up, K, Bart, K, Marko, K, Kris, K, Florence, L, Rohit, L, Robert, M, Timothy R, M, Elisabeth, P, Michael, R, Manuel, R, Marcelo, S, Shivaram Prasad, S, Silvia C, S, C Wendy, S, Dina, T, Luca, V, Miriam B, V, Vincent, W, Stavra, X, Yusuf, Y, Zobair, Y, Ansley, H, Marcela, V, Newsome, NVeeral Ajmeral, P, Alazawi, W, Alkhatry, M, Alkhouri, N, Allen, A, Allison, M, Alswat, K, R Alvares-da-Silva, M, Alves-Bezerra, M, J Armstrong, M, Arufe, D, Aschner, P, Baffy, G, Bansal, M, Bedossa, P, Belfort, R, Berg, T, Berzigotti, A, Betel, M, Bianco, C, Brass, C, L Brosgart, C, Matthews Brunt, E, Buti, M, Caldwell, S, Carr, R, Casanovas, T, Castera, L, Caussy, C, Cerda, E, Chalasani, N, Kheong Chan, W, Charatcharoenwitthaya, P, Charlton, M, Cheung, A, Chiodi, D, Chung, R, Cohen, D, Corey, K, P Cotrim, H, Crespo, J, Dassanayake, A, Davidson, N, De Knegt, R, De Ledinghen, V, Demir, M, Diaz, S, Mae Diehl, A, Dimmig, B, Dirchwolf, M, Duseja, A, Dvorak, K, Ekstedt, M, El Wakil, R, Lucía Ferraz, M, Friedman, S, Fuchs, M, Gastaldelli, A, Geerts, A, Geier, A, Girala, M, Goh, G, Goossens, N, Graupera, I, Hagström, H, Henry, Z, Hunyady, B, Hutchison, A, Isaacs, S, Jornayvaz, F, Kemp, C, Kile, D, Kim, W, Kleiner, D, Kohli, R, Kugelmas, M, Lavine, J, Lazo, M, Leite, N, Lozano, A, Luukkonen, P, Macedo, P, Mansour, D, Mantzoros, C, Marchesini, G, Marciano, S, Martinez, K, Vladimirova Mateva, L, M Mato, J, Mccary, A, Miele, L, Mikolasevic, I, Miller, V, Moreno, R, Moylan, C, Nakajima, A, Charles Nault, J, Norris, S, Noureddin, M, P Oliveira, C, Ong, A, Padilla, M, Pais, R, Panduro, A, K Panigrahi, M, Papatheodoridis, G, Pelusi, S, Pérez, M, Perez Escobar, J, Perseghin, G, Pessoa, M, Petta, S, Pinzani, M, Platon Lupsor, M, Rabiee, A, Romeo, S, Rotman, Y, Rowe, I, Salupere, R, Satapathy, S, M Schattenberg, J, Schaufert, W, Schnabl, B, Seim, L, Serfaty, L, Shapiro, D, K Singal, A, Skladany, L, Stefan, N, Stine, J, Sundaram, S, Svegliati-Baroni, G, Szabo, G, Tacke, F, Tanwandee, T, Targher, G, Terrault, N, Tetri, B, Thiele, M, Tisthammer, B, Torre Delgadillo, A, Trauner, M, Tsochatzis, E, Van Kleef, L, Van Mil, S, Vanwagner, L, Antonio Velarde Ruiz Velasco, J, Vesterhus, M, Vilar-Gomez, E, Watt, K, Wattacheril, J, Wilkins, F, Willemse, J, Zekry, A, Zelber-Sagi, S, Rinella, Mary E, Lazarus, Jeffrey V, Ratziu, Vlad, Francque, Sven M, Sanyal, Arun J, Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal F, Anstee, Quentin M, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher, Castro Narro, Graciela E, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna, Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D, Harrison, Stephen A, Kim, Seung Up, Koot, Bart, Korenjak, Marko, Kowdley, Kris, Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R, Powell, Elisabeth, Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C, Spearman, C Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B, Wai-Sun Wong, Vincent, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Philip NVeeral Ajmeral, William Alazawi, Maryam Alkhatry, Naim Alkhouri, Alina Allen, Michael Allison, Khalid Alswat, Mario R Alvares-da-Silva, Michele Alves-Bezerra, Matthew J Armstrong, Diego Arufe, Pablo Aschner, Gyorgy Baffy, Meena Bansal, Pierre Bedossa, Renata Belfort, Thomas Berg, Annalisa Berzigotti, Michael Betel, Cristiana Bianco, Clifford Brass, Carol L Brosgart, Elizabeth Matthews Brunt, Maria Buti, Steve Caldwell, Rotonya Carr, Teresa Casanovas, Laurent Castera, Cyrielle Caussy, Eira Cerda, Naga Chalasani, Wah Kheong Chan, Phunchai Charatcharoenwitthaya, Michael Charlton, Amanda Cheung, Daniela Chiodi, Ray Chung, David Cohen, Kathleen Corey, Helma P Cotrim, Javier Crespo, Anuradha Dassanayake, Nicholas Davidson, Robert De Knegt, Victor De Ledinghen, Münevver Demir, Sebastian Diaz, Anna Mae Diehl, Bruce Dimmig, Melisa Dirchwolf, Ajay Duseja, Karel Dvorak, Mattias Ekstedt, Reda El Wakil, María Lucía Ferraz, Scott Friedman, Michael Fuchs, Amalia Gastaldelli, Anja Geerts, Andreas Geier, Marcos Girala, George Goh, Nicolas Goossens, Isabel Graupera, Hannes Hagström, Zachary Henry, Bela Hunyady, Alan Hutchison, Scott Isaacs, François Jornayvaz, Cynthia Kemp, Denise Kile, Won Kim, David Kleiner, Rohit Kohli, Marcelo Kugelmas, Joel Lavine, Mariana Lazo, Nathalie Leite, Adelina Lozano, Panu Luukkonen, Paula Macedo, Dina Mansour, Christos Mantzoros, Giulio Marchesini, Sebastián Marciano, Kim Martinez, Lyudmila Vladimirova Mateva, Jose M Mato, Alexis McCary, Luca Miele, Ivana Mikolasevic, Veronica Miller, Rosalba Moreno, Cynthia Moylan, Atsushi Nakajima, Jean Charles Nault, Suzanne Norris, Mazen Noureddin, C P Oliveira, Arlin Ong, Martín Padilla, Raluca Pais, Arturo Panduro, Manas K Panigrahi, George Papatheodoridis, Serena Pelusi, Marlene Pérez, Juanita Perez Escobar, Gianluca Perseghin, Mario Pessoa, Salvatore Petta, Massimo Pinzani, Monica Platon Lupsor, Atoosa Rabiee, Stefano Romeo, Yaron Rotman, Ian Rowe, Riina Salupere, Sanjaya Satapathy, Jörn M Schattenberg, Wendy Schaufert, Bernd Schnabl, Lynn Seim, Lawrence Serfaty, David Shapiro, Ashwani K Singal, Lubomir Skladany, Norbert Stefan, Jonathan Stine, Shikha Sundaram, Gianluca Svegliati-Baroni, Gyonzgi Szabo, Frank Tacke, Tawesak Tanwandee, Giovanni Targher, Norah Terrault, Brent Tetri, Maja Thiele, Baron Tisthammer, Aldo Torre Delgadillo, Michael Trauner, Emmanuel Tsochatzis, Laurens Van Kleef, Saskia Van Mil, Lisa VanWagner, Jose Antonio Velarde Ruiz Velasco, Mette Vesterhus, Eduardo Vilar-Gomez, Kymberly Watt, Julia Wattacheril, Fonda Wilkins, José Willemse, Amany Zekry, Shira Zelber-Sagi, Mary E, R, Jeffrey V, L, Vlad, R, Sven M, F, Arun J, S, Fasiha, K, Diana, R, Manal F, A, Quentin M, A, Juan Pablo, A, Marco, A, Ramon, B, Ulrich, B, Jerome, B, Elisabetta, B, Christopher, B, Graciela E, C, Abhijit, C, Helena, C, Donna, C, Kenneth, C, Mohamed, E, Samuel, K, Wayne, E, Jiangao, F, Samer, G, Cynthia D, G, Stephen A, H, Seung Up, K, Bart, K, Marko, K, Kris, K, Florence, L, Rohit, L, Robert, M, Timothy R, M, Elisabeth, P, Michael, R, Manuel, R, Marcelo, S, Shivaram Prasad, S, Silvia C, S, C Wendy, S, Dina, T, Luca, V, Miriam B, V, Vincent, W, Stavra, X, Yusuf, Y, Zobair, Y, Ansley, H, Marcela, V, Newsome, NVeeral Ajmeral, P, Alazawi, W, Alkhatry, M, Alkhouri, N, Allen, A, Allison, M, Alswat, K, R Alvares-da-Silva, M, Alves-Bezerra, M, J Armstrong, M, Arufe, D, Aschner, P, Baffy, G, Bansal, M, Bedossa, P, Belfort, R, Berg, T, Berzigotti, A, Betel, M, Bianco, C, Brass, C, L Brosgart, C, Matthews Brunt, E, Buti, M, Caldwell, S, Carr, R, Casanovas, T, Castera, L, Caussy, C, Cerda, E, Chalasani, N, Kheong Chan, W, Charatcharoenwitthaya, P, Charlton, M, Cheung, A, Chiodi, D, Chung, R, Cohen, D, Corey, K, P Cotrim, H, Crespo, J, Dassanayake, A, Davidson, N, De Knegt, R, De Ledinghen, V, Demir, M, Diaz, S, Mae Diehl, A, Dimmig, B, Dirchwolf, M, Duseja, A, Dvorak, K, Ekstedt, M, El Wakil, R, Lucía Ferraz, M, Friedman, S, Fuchs, M, Gastaldelli, A, Geerts, A, Geier, A, Girala, M, Goh, G, Goossens, N, Graupera, I, Hagström, H, Henry, Z, Hunyady, B, Hutchison, A, Isaacs, S, Jornayvaz, F, Kemp, C, Kile, D, Kim, W, Kleiner, D, Kohli, R, Kugelmas, M, Lavine, J, Lazo, M, Leite, N, Lozano, A, Luukkonen, P, Macedo, P, Mansour, D, Mantzoros, C, Marchesini, G, Marciano, S, Martinez, K, Vladimirova Mateva, L, M Mato, J, Mccary, A, Miele, L, Mikolasevic, I, Miller, V, Moreno, R, Moylan, C, Nakajima, A, Charles Nault, J, Norris, S, Noureddin, M, P Oliveira, C, Ong, A, Padilla, M, Pais, R, Panduro, A, K Panigrahi, M, Papatheodoridis, G, Pelusi, S, Pérez, M, Perez Escobar, J, Perseghin, G, Pessoa, M, Petta, S, Pinzani, M, Platon Lupsor, M, Rabiee, A, Romeo, S, Rotman, Y, Rowe, I, Salupere, R, Satapathy, S, M Schattenberg, J, Schaufert, W, Schnabl, B, Seim, L, Serfaty, L, Shapiro, D, K Singal, A, Skladany, L, Stefan, N, Stine, J, Sundaram, S, Svegliati-Baroni, G, Szabo, G, Tacke, F, Tanwandee, T, Targher, G, Terrault, N, Tetri, B, Thiele, M, Tisthammer, B, Torre Delgadillo, A, Trauner, M, Tsochatzis, E, Van Kleef, L, Van Mil, S, Vanwagner, L, Antonio Velarde Ruiz Velasco, J, Vesterhus, M, Vilar-Gomez, E, Watt, K, Wattacheril, J, Wilkins, F, Willemse, J, Zekry, A, Zelber-Sagi, S, Rinella, Mary E, Lazarus, Jeffrey V, Ratziu, Vlad, Francque, Sven M, Sanyal, Arun J, Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal F, Anstee, Quentin M, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher, Castro Narro, Graciela E, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna, Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D, Harrison, Stephen A, Kim, Seung Up, Koot, Bart, Korenjak, Marko, Kowdley, Kris, Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R, Powell, Elisabeth, Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C, Spearman, C Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B, Wai-Sun Wong, Vincent, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Philip NVeeral Ajmeral, William Alazawi, Maryam Alkhatry, Naim Alkhouri, Alina Allen, Michael Allison, Khalid Alswat, Mario R Alvares-da-Silva, Michele Alves-Bezerra, Matthew J Armstrong, Diego Arufe, Pablo Aschner, Gyorgy Baffy, Meena Bansal, Pierre Bedossa, Renata Belfort, Thomas Berg, Annalisa Berzigotti, Michael Betel, Cristiana Bianco, Clifford Brass, Carol L Brosgart, Elizabeth Matthews Brunt, Maria Buti, Steve Caldwell, Rotonya Carr, Teresa Casanovas, Laurent Castera, Cyrielle Caussy, Eira Cerda, Naga Chalasani, Wah Kheong Chan, Phunchai Charatcharoenwitthaya, Michael Charlton, Amanda Cheung, Daniela Chiodi, Ray Chung, David Cohen, Kathleen Corey, Helma P Cotrim, Javier Crespo, Anuradha Dassanayake, Nicholas Davidson, Robert De Knegt, Victor De Ledinghen, Münevver Demir, Sebastian Diaz, Anna Mae Diehl, Bruce Dimmig, Melisa Dirchwolf, Ajay Duseja, Karel Dvorak, Mattias Ekstedt, Reda El Wakil, María Lucía Ferraz, Scott Friedman, Michael Fuchs, Amalia Gastaldelli, Anja Geerts, Andreas Geier, Marcos Girala, George Goh, Nicolas Goossens, Isabel Graupera, Hannes Hagström, Zachary Henry, Bela Hunyady, Alan Hutchison, Scott Isaacs, François Jornayvaz, Cynthia Kemp, Denise Kile, Won Kim, David Kleiner, Rohit Kohli, Marcelo Kugelmas, Joel Lavine, Mariana Lazo, Nathalie Leite, Adelina Lozano, Panu Luukkonen, Paula Macedo, Dina Mansour, Christos Mantzoros, Giulio Marchesini, Sebastián Marciano, Kim Martinez, Lyudmila Vladimirova Mateva, Jose M Mato, Alexis McCary, Luca Miele, Ivana Mikolasevic, Veronica Miller, Rosalba Moreno, Cynthia Moylan, Atsushi Nakajima, Jean Charles Nault, Suzanne Norris, Mazen Noureddin, C P Oliveira, Arlin Ong, Martín Padilla, Raluca Pais, Arturo Panduro, Manas K Panigrahi, George Papatheodoridis, Serena Pelusi, Marlene Pérez, Juanita Perez Escobar, Gianluca Perseghin, Mario Pessoa, Salvatore Petta, Massimo Pinzani, Monica Platon Lupsor, Atoosa Rabiee, Stefano Romeo, Yaron Rotman, Ian Rowe, Riina Salupere, Sanjaya Satapathy, Jörn M Schattenberg, Wendy Schaufert, Bernd Schnabl, Lynn Seim, Lawrence Serfaty, David Shapiro, Ashwani K Singal, Lubomir Skladany, Norbert Stefan, Jonathan Stine, Shikha Sundaram, Gianluca Svegliati-Baroni, Gyonzgi Szabo, Frank Tacke, Tawesak Tanwandee, Giovanni Targher, Norah Terrault, Brent Tetri, Maja Thiele, Baron Tisthammer, Aldo Torre Delgadillo, Michael Trauner, Emmanuel Tsochatzis, Laurens Van Kleef, Saskia Van Mil, Lisa VanWagner, Jose Antonio Velarde Ruiz Velasco, Mette Vesterhus, Eduardo Vilar-Gomez, Kymberly Watt, Julia Wattacheril, Fonda Wilkins, José Willemse, Amany Zekry, and Shira Zelber-Sagi

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 favour 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 panellists 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 (MASLD). 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 non-stigmati

Published
2023

33. A multi-society Delphi consensus statement on new fatty liver disease nomenclature

Author

Rinella, Mary E, Lazarus, Jeffrey V, Ratziu, Vlad, Francque, Sven M, Sanyal, Arun J, Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal F, Anstee, Quentin M, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher, Castro Narro, Graciela E, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna, Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D, Harrison, Stephen A, Kim, Seung Up, Koot, Bart, Korenjak, Marko, Kowdley, Kri, Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R, Powell, Elisabeth, Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C, Spearman, C Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B, Wai-Sun Wong, Vincent, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Newsome, Philip N, Miele, Luca, NAFLD Nomenclature consensus, Group, Miele, Luca (ORCID:0000-0003-3464-0068), Rinella, Mary E, Lazarus, Jeffrey V, Ratziu, Vlad, Francque, Sven M, Sanyal, Arun J, Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal F, Anstee, Quentin M, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramon, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher, Castro Narro, Graciela E, Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna, Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D, Harrison, Stephen A, Kim, Seung Up, Koot, Bart, Korenjak, Marko, Kowdley, Kri, Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R, Powell, Elisabeth, Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C, Spearman, C Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B, Wai-Sun Wong, Vincent, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Newsome, Philip N, Miele, Luca, NAFLD Nomenclature consensus, Group, and Miele, Luca (ORCID:0000-0003-3464-0068)

Abstract

Unlabelled: The principal limitations of the terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (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 favour of a change in nomenclature and/or definition. Methods: A modified Delphi process was led by three large pan-national liver associations. 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. Results: A total of 236 panellists from 56 countries participated in four online surveys and two hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83% and 78%, respectively. 74% of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms 'non-alcoholic' and 'fatty' were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease (SLD) 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 (MASLD). There was consensus to change the definition to include the presence of at least one of five cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic SLD. A new category, outside pure MASLD, termed MetALD was selected to describe those with MASLD who consume greater amounts of alcohol per week (140 to 350 g/week and 210 to 420 g/week for females and males respectively). Conclusions: The new nomenclature and diagnostic criteria are widely supported, non-stigmatising and can improve awareness and patient identification.

Published
2023

34. Research Priorities for Precision Medicine in NAFLD

Author

Iruzubieta, Paula, Bataller, Ramón, Arias-Loste, María Teresa, Arrese, Marco, Calleja, José Luis, Castro Narro, Graciela E., Cusi, Kenneth, Dillon, John F., Martínez-Chantar, María Luz, Mateo, Miguel, Pérez, Antonio, Rinella, Mary E., Romero-Gómez, Manuel, Schattenberg, Jörn M., Zelber-Sagi, Shira, Crespo, Javier, Lazarus, Jeffrey V., Iruzubieta, Paula, Bataller, Ramón, Arias-Loste, María Teresa, Arrese, Marco, Calleja, José Luis, Castro Narro, Graciela E., Cusi, Kenneth, Dillon, John F., Martínez-Chantar, María Luz, Mateo, Miguel, Pérez, Antonio, Rinella, Mary E., Romero-Gómez, Manuel, Schattenberg, Jörn M., Zelber-Sagi, Shira, Crespo, Javier, and Lazarus, Jeffrey V.

Published
2023

35. Real-world evidence on non-invasive tests and associated cut-offs used to assess fibrosis in routine clinical practice

Author

Lazarus, Jeffrey V., Castera, Laurent, Mark, Henry E., Allen, Alina M., Adams, Leon A., Anstee, Quentin M., Arrese, Marco, Alqahtani, Saleh A., Bugianesi, Elisabetta, Colombo, Massimo, Cusi, Kenneth, Hagström, Hannes, Loomba, Rohit, Romero-Gómez, Manuel, Schattenberg, Jörn M., Thiele, Maja, Valenti, Luca, Wai-Sun Wong, Vincent, Yilmaz, Yusuf, Younossi, Zobair M., Francque, Sven M., Tsochatzis, Emmanuel A., Lazarus, Jeffrey V., Castera, Laurent, Mark, Henry E., Allen, Alina M., Adams, Leon A., Anstee, Quentin M., Arrese, Marco, Alqahtani, Saleh A., Bugianesi, Elisabetta, Colombo, Massimo, Cusi, Kenneth, Hagström, Hannes, Loomba, Rohit, Romero-Gómez, Manuel, Schattenberg, Jörn M., Thiele, Maja, Valenti, Luca, Wai-Sun Wong, Vincent, Yilmaz, Yusuf, Younossi, Zobair M., Francque, Sven M., and Tsochatzis, Emmanuel A.

Abstract

[Background & Aims] Non-invasive tests (NITs) offer a practical solution for advanced fibrosis identification in non-alcoholic fatty liver disease (NAFLD). Despite increasing implementation, their use is not standardised, which can lead to inconsistent interpretation and risk stratification. We aimed to assess the types of NITs and the corresponding cut-offs used in a range of healthcare settings., [Methods] A survey was distributed to a convenience sample of liver health experts who participated in a global NAFLD consensus statement. Respondents provided information on the NITs used in their clinic with the corresponding cut-offs and those used in established care pathways in their areas., [Results] There were 35 respondents from 24 countries, 89% of whom practised in tertiary level settings. A total of 14 different NITs were used, and each respondent reported using at least one (median = 3). Of the respondents, 80% reported using FIB-4 and liver stiffness by vibration-controlled transient elastography (Fibroscan®), followed by the NAFLD fibrosis score (49%). For FIB-4, 71% of respondents used a low cut-off of <1.3 (range <1.0 to <1.45) and 21% reported using age-specific cut-offs. For Fibroscan®, 21% of respondents used a single liver stiffness cut-off: 8 kPa in 50%, while the rest used 7.2 kPa, 7.8 kPa and 8.7 kPa. Among the 63% of respondents who used lower and upper liver stiffness cut-offs, there were variations in both values (<5 to <10 kPa and >7.5 to >20 kPa, respectively)., [Conclusions] The cut-offs used for the same NITs for NAFLD risk stratification vary between clinicians. As cut-offs impact test performance, these findings underscore the heterogeneity in risk-assessment and support the importance of establishing consistent guidelines on the standardised use of NITs in NAFLD management., [Lay summary] Owing to the high prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population it is important to identify those who have more advanced stages of liver fibrosis, so that they can be properly treated. Non-invasive tests (NITs) provide a practical way to assess fibrosis risk in patients. However, we found that the cut-offs used for the same NITs vary between clinicians. As cut-offs impact test performance, these findings highlight the importance of establishing consistent guidelines on the standardised use of NITs to optimise clinical management of NAFLD.

Published
2023

36. A multisociety Delphi consensus statement on new fatty liver disease nomenclature

Author

Rinella, Mary E., Lazarus, Jeffrey V., Ratziu, Vlad, Francque, Sven M., Sanyal, Arun J., Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal, Anstee, Quentin, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramón, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher D., Castro Narro, Graciela E., Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna R., Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D., Harrison, Stephen A., Kim, Seung Up, Koot, Bart G., Korenjak, Marko, Kowdley, Kris V., Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R., Powell, Elisabeth E., Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C., Spearman, C. Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B., Wong, Vincent Wai-Sun, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Newsome, Philip N., on behalf of the NAFLD Nomenclature consensus group, Rinella, Mary E., Lazarus, Jeffrey V., Ratziu, Vlad, Francque, Sven M., Sanyal, Arun J., Kanwal, Fasiha, Romero, Diana, Abdelmalek, Manal, Anstee, Quentin, Arab, Juan Pablo, Arrese, Marco, Bataller, Ramón, Beuers, Ulrich, Boursier, Jerome, Bugianesi, Elisabetta, Byrne, Christopher D., Castro Narro, Graciela E., Chowdhury, Abhijit, Cortez-Pinto, Helena, Cryer, Donna R., Cusi, Kenneth, El-Kassas, Mohamed, Klein, Samuel, Eskridge, Wayne, Fan, Jiangao, Gawrieh, Samer, Guy, Cynthia D., Harrison, Stephen A., Kim, Seung Up, Koot, Bart G., Korenjak, Marko, Kowdley, Kris V., Lacaille, Florence, Loomba, Rohit, Mitchell-Thain, Robert, Morgan, Timothy R., Powell, Elisabeth E., Roden, Michael, Romero-Gómez, Manuel, Silva, Marcelo, Singh, Shivaram Prasad, Sookoian, Silvia C., Spearman, C. Wendy, Tiniakos, Dina, Valenti, Luca, Vos, Miriam B., Wong, Vincent Wai-Sun, Xanthakos, Stavra, Yilmaz, Yusuf, Younossi, Zobair, Hobbs, Ansley, Villota-Rivas, Marcela, Newsome, Philip N., and on behalf of the NAFLD Nomenclature consensus group

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 c

Published
2023

37. Introduction and Methodology: Standards of Care in Diabetes—2024.

Author

American Diabetes Association Professional Practice Committee, ElSayed, Nuha A., Aleppo, Grazia, Bannuru, Raveendhara R., Beverly, Elizabeth A., Bruemmer, Dennis, Collins, Billy S., Cusi, Kenneth, Darville, Audrey, Das, Sandeep R., Ekhlaspour, Laya, Fleming, Talya K., Gaglia, Jason L., Galindo, Rodolfo J., Gibbons, Christopher H., Giurini, John M., Hassanein, Mohamed, Hilliard, Marisa E., Johnson, Eric L., and Khunti, Kamlesh

Subjects
MEDICAL personnel, DIABETES, TYPE 1 diabetes, TYPE 2 diabetes, DIABETIC foot, DIABETIC retinopathy, FOOT diseases
Abstract

The article presents the discussion on significant evidence exists that supports a range of interventions to improve diabetes outcomes. Topics include diabetes is a complex, chronic condition requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic management; and provide comprehensive management plans for conditions that require specialized care, such as mental illness.

Published
2024
Full Text
View/download PDF

38. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2024.

Author

American Diabetes Association Professional Practice Committee, ElSayed, Nuha A., Aleppo, Grazia, Bannuru, Raveendhara R., Bruemmer, Dennis, Collins, Billy S., Cusi, Kenneth, Ekhlaspour, Laya, Fleming, Talya K., Hilliard, Marisa E., Johnson, Eric L., Khunti, Kamlesh, Lingvay, Ildiko, Matfin, Glenn, McCoy, Rozalina G., Napoli, Nicola, Perry, Mary Lou, Pilla, Scott J., Polsky, Sarit, and Prahalad, Priya

Subjects
DIABETES, PROFESSIONAL practice
Abstract

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
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39. A global research priority agenda to advance public health responses to fatty liver disease

Author

Lazarus, Jeffrey V, Mark, Henry E, Allen, Alina M, Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A, Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N, Burra, Patrizia, Castro-Narro, Graciela E, Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M, Hagström, Hannes, Huang, Terry T-K, Wajcman, Dana Ivancovsky, Kautz, Achim, Kopka, Christopher J, Krag, Aleksander, Miller, Veronica, Newsome, Philip N, Rinella, Mary E, Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C Wendy, Tsochatzis, Emmanuel A, Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M, Wong, Vincent Wai-Sun, Younossi, Zobair M, Gianluca Perseghin, Jeffrey V, L, Henry E, M, Alina M, A, Juan Pablo, A, Patrizia, C, Mazen, N, William, A, Naim, A, Saleh A, A, Marco, A, Ramon, B, Thomas, B, Paul N, B, Patrizia, B, Graciela E, C, Helena, C, Kenneth, C, Nikos, D, Ajay, D, Sven M, F, Hannes, H, Terry T-K, H, Dana Ivancovsky, W, Achim, K, Christopher J, K, Aleksander, K, Veronica, M, Philip N, N, Mary E, R, Diana, R, Shiv Kumar, S, Marcelo, S, C Wendy, S, Emmanuel A, T, Luca, V, Marcela, V, Shira, Z, Jörn M, S, Vincent Wai-Sun, W, Younossi, M, Z, and Perseghin, G

Subjects
Non-communicable disease (NCD), Steatotic liver disease, Delphi method, Global health, NAFLD/NASH
Abstract

Background & aims: An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods: Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results: The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of 'agree' responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement ('agree' + 'somewhat agree'); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% 'agree'), 13 priorities had 90% combined agreement. Conclusions: Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community's efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications: An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat.

Published
2023

40. Abdominal obesity and dsyglycemia are risk factors for liver fibrosis progression in NAFLD subjects: A population-based study

Author

Julián, María Teresa, primary, Ballesta, Sílvia, additional, Pera, Guillem, additional, Pérez-Montes de Oca, Alejandra, additional, Soldevila, Berta, additional, Caballería, Llorenç, additional, Morillas, Rosa, additional, Expósito, Carmen, additional, Martínez–Escudé, Alba, additional, Puig-Domingo, Manel, additional, Franch-Nadal, Josep, additional, Torán, Pere, additional, Cusi, Kenneth, additional, Julve, Josep, additional, Mauricio, Dídac, additional, and Alonso, Núria, additional

Published
2023
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41. Introduction and Methodology: Standards of Care in Diabetes—2023

Author

ElSayed, Nuha A., primary, Aleppo, Grazia, additional, Aroda, Vanita R., additional, Bannuru, Raveendhara R., additional, Brown, Florence M., additional, Bruemmer, Dennis, additional, Collins, Billy S., additional, Cusi, Kenneth, additional, Das, Sandeep R., additional, Gibbons, Christopher H., additional, Giurini, John M., additional, Hilliard, Marisa E., additional, Isaacs, Diana, additional, Johnson, Eric L., additional, Kahan, Scott, additional, Khunti, Kamlesh, additional, Kosiborod, Mikhail, additional, Leon, Jose, additional, Lyons, Sarah K., additional, Murdock, Lisa, additional, Perry, Mary Lou, additional, Prahalad, Priya, additional, Pratley, Richard E., additional, Seley, Jane Jeffrie, additional, Stanton, Robert C., additional, Sun, Jennifer K., additional, Woodward, Crystal C., additional, Young-Hyman, Deborah, additional, and Gabbay, Robert A., additional

Published
2022
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42. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2023

Author

ElSayed, Nuha A., primary, Aleppo, Grazia, additional, Aroda, Vanita R., additional, Bannuru, Raveendhara R., additional, Brown, Florence M., additional, Bruemmer, Dennis, additional, Collins, Billy S., additional, Cusi, Kenneth, additional, Hilliard, Marisa E., additional, Isaacs, Diana, additional, Johnson, Eric L., additional, Kahan, Scott, additional, Khunti, Kamlesh, additional, Leon, Jose, additional, Lyons, Sarah K., additional, Perry, Mary Lou, additional, Prahalad, Priya, additional, Pratley, Richard E., additional, Seley, Jane Jeffrie, additional, Stanton, Robert C., additional, and Gabbay, Robert A., additional

Published
2022
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46. Reply

Author

Kanwal, Fasiha, Shubrook, Jay H., and Cusi, Kenneth

Published
2022
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