A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement

JOURNAL OF HEPATOLOGY

卷:73

Article

Eslam, Mohammed^1,2  Newsome, Philip N.^3,4,5,6  Sarin, Shiv K.⁷  Anstee, Quentin M.^8,9  Targher, Giovanni^10,11  Romero-Gomez, Manuel¹²  Zelber-Sagi, Shira^13,14  Wong, Vincent Wai-Sun¹⁵  Dufour, Jean-Francois^16,17  Schattenberg, Joern M.¹⁸  Kawaguchi, Takumi¹⁹  Arrese, Marco^20,21  Valenti, Luca^22,23  Shiha, Gamal²⁴  Tiribelli, Claudio²⁵  Yki-Jarvinen, Hannele^26,27,28  Fan, Jian-Gao²⁹  Gronbaek, Henning³⁰  Yilmaz, Yusuf^31,32  Cortez-Pinto, Helena³³  Oliveira, Claudia P.³⁴  Bedossa, Pierre³⁵  Adams, Leon A.³⁶  Zheng, Ming-Hua^37,38  Fouad, Yasser³⁹  Chan, Wah-Kheong⁴⁰  Mendez-Sanchez, Nahum^41,42  Ahn, Sang Hoon⁴³  Castera, Laurent⁴⁴  Bugianesi, Elisabetta⁴⁵  Ratziu, Vlad⁴⁶  George, Jacob^1,2 

[1] Westmead Hosp, Storr Liver Ctr, Westmead Inst Med Res, Westmead, NSW 2145, Australia

[2] Univ Sydney, Westmead, NSW 2145, Australia

[3] Univ Hosp Birmingham NHS Fdn Trust, Natl Inst Hlth Res Biomed Res Ctr, Birmingham, W Midlands, England

[4] Univ Birmingham, Birmingham, W Midlands, England

[5] Univ Birmingham, Ctr Liver & Gastrointestinal Res, Inst Immunol & Immunotherapy, Birmingham, W Midlands, England

[6] Univ Hosp Birmingham NHS Fdn Trust, Liver Unit, Birmingham, W Midlands, England

[7] Inst Liver & Biliary Sci, Dept Hepatol, New Delhi, India

[8] Newcastle Univ, Translat & Clin Res Inst, Fac Med Sci, Newcastle Upon Tyne, Tyne & Wear, England

[9] Newcastle Upon Tyne Hosp NHS Fdn Trust, Newcastle NIHR Biomed Res Ctr, Newcastle Upon Tyne, Tyne & Wear, England

[10] Univ Verona, Dept Med, Sect Endocrinol Diabet & Metab, Verona, Italy

[11] Azienda Osped Univ Integrata Verona, Verona, Italy

[12] Univ Seville, Virgen del Rocio Univ Hosp, Inst Biomed Sevilla, CIBEREHD,UCM Digest Dis, Seville, Spain

[13] Univ Haifa, Sch Publ Hlth, Haifa, Israel

[14] Tel Aviv Med Ctr & Sch Med, Dept Gastroenterol, Tel Aviv, Israel

[15] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Peoples R China

[16] Univ Bern, Univ Clin Visceral Surg & Med, Inselspital, Bern, Switzerland

[17] Univ Bern, Dept Biomed Res, Bern, Switzerland

[18] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med, Mainz, Germany

[19] Kurume Univ, Dept Med, Div Gastroenterol, Sch Med, Kurume, Fukuoka, Japan

[20] Pontificia Univ Catolica Chile, Dept Gastroenterol, Escuela Med, Santiago, Chile

[21] Pontificia Univ Catolica Chile, Ctr Envejecimiento & Regenerac CARE, Dept Biol Celular & Mol, Fac Ciencias Biol, Santiago, Chile

[22] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy

[23] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Transfus Med & Hematol, Translat Med, Milan, Italy

[24] Mansoura Univ, Fac Med, Internal Med Dept, Hepatol & Gastroenterol Unit, Mansoura, Egypt

[25] Italian Liver Fdn, Liver Ctr, Trieste, Italy

[26] Univ Helsinki, Dept Med, Helsinki, Finland

[27] Helsinki Univ Hosp, Helsinki, Finland

[28] Minerva Fdn, Helsinki, Finland

[29] Shanghai Jiao Tong Univ, Ctr Fatty Liver, Dept Gastroenterol, Xin Hua Hosp,Sch Med,Shanghai Key Lab Pediat Gast, Shanghai, Peoples R China

[30] Aarhus Univ Hosp, Dept Hepatol & Gastroenterol, Aarhus, Denmark

[31] Marmara Univ, Sch Med, Dept Gastroenterol, Istanbul, Turkey

[32] Marmara Univ, Inst Gastroenterol, Istanbul, Turkey

[33] Univ Lisbon, Clin Univ Gastrenterol, Fac Med, Lab Nutr, Lisbon, Portugal

[34] Univ Sao Paulo, Sch Med, Dept Gastroenterol, Sao Paulo, Brazil

[35] Paris Diderot Univ, Dept Pathol Physiol & Imaging, Beaujon Hosp, Paris, France

[36] Univ Western Australia, Sir Charles Gairdner Hosp Unit, Med Sch, Nedlands, WA, Australia

[37] Wenzhou Med Univ, Affiliated Hosp 1, NAFLD Res Ctr, Dept Hepatol, Wenzhou, Peoples R China

[38] Wenzhou Med Univ, Inst Hepatol, Wenzhou, Peoples R China

[39] Minia Univ Hosp, Fac Med, Dept Gastroenterol Hepatol & Endem Med, Al Minya, Egypt

[40] Univ Malaya, Fac Med, Dept Med, Gastroenterol & Hepatol Unit, Kuala Lumpur, Malaysia

[41] Univ Nacl Autonoma Mexico, Med Sur Clin & Fdn, Liver Res Unit, Mexico City, DF, Mexico

[42] Univ Nacl Autonoma Mexico, Fac Med, Mexico City, DF, Mexico

[43] Yonsei Univ, Dept Internal Med, Coll Med, Seoul, South Korea

[44] Univ Paris VII, Ctr Rech Inflammat, Inserm Umr 1149, Paris, France

[45] Univ Turin, Dept Med Sci, Div Gastroenterol & Hepatol, Turin, Italy

[46] Sorbonne Univ, Inst Cardiometab & Nutr ICAN, Hop Pitie Salpetriere, AP HP, Paris, France

关键词: MAFLD;    Cirrhosis;    Diagnostic criteria;    Metabolic;    NAFLD;    Steatohepatitis;    Diabetes;    Obesity;   

DOI  :  10.1016/j.jhep.2020.03.039

来源: Elsevier

【 摘 要 】

The exclusion of other chronic liver diseases including excess alcohol intake has until now been necessary to establish a diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). However, given our current understanding of the pathogenesis of MAFLD and its rising prevalence, positive criteria to diagnose the disease are required. In this work, a panel of international experts from 22 countries propose a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and is independent of other liver diseases. The criteria are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose that disease assessment and stratification of severity should extend beyond a simple dichotomous classification to steatohepatitis vs. non-steatohepatitis. The group also suggests a set of criteria to define MAFLD-associated cirrhosis and proposes a conceptual framework to consider other causes of fatty liver disease. Finally, we bring clarity to the distinction between diagnostic criteria and inclusion criteria for research studies and clinical trials. Reaching consensus on the criteria for MAFLD will help unify the terminology (e.g. for ICD-coding), enhance the legitimacy of clinical practice and clinical trials, improve clinical care and move the clinical and scientific field of liver research forward. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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