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      NAFLD vs MAFLD: South Asian NAFLD Patients don't Favor Name Change

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          A bstract

          Aim

          There have been vociferous attempts to change the name of Nonalcoholic Fatty Liver Disease (NAFLD) to Metabolic Associated Fatty Liver Disease (MAFLD). Of the many arguments put forth in support of this, an important one is the presumed demand by patient groups insisting on the change. However, this claim does not have credible evidence to support it. Therefore, we decided to conduct a survey among South Asian NAFLD patients to understand their perspectives with regard to the change in nomenclature.

          Materials and Methods

          The study was conducted at multiple centers across South Asia from January 2021 to June 2021. Patients were surveyed using an 8-question survey questionnaire and responses were categorized by multiple-choice format.

          Results

          Of 218 patients surveyed, 80.3% of the patients were not aware of the entity “NAFLD” before they were first diagnosed. Although 74.3% of patients admitted to being questioned about alcohol intake at the time of the first diagnosis, 75.9% of female patients were not questioned regarding this. After being labelled NAFLD, 92.1% of patients were never questioned again about alcohol intake. While 86.3% of patients found the term “NAFLD” consoling, 83% did not feel that “Non” in NAFLD trivialized their problem. In addition, only 6.9% of patients were scared of developing cardiovascular disease.

          Conclusion

          The term “NAFLD” destigmatizes patients of the taboo associated with alcohol use. It was found to be consoling to most patients and they did not feel it trivialized their problem. A change of name without considering patients’ perspectives and peculiarities specific to different populations will have enormous ramifications for both patients and physicians.

          Clinical significance

          Our survey clearly shows that patients are happy with the term “NAFLD” and it effectively destigmatizes them from the taboo of alcohol. This would lead to higher compliance with management and greater patient participation in future studies and trials.

          How to cite this article

          Singh SP, Anirvan P, Butt AS, et al. NAFLD vs MAFLD: South Asian NAFLD Patients don't Favor Name Change. Euroasian J Hepato-Gastroenterol 2022;12(Suppl 1):S1–S4.

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          Most cited references19

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          Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.

          Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. We estimated the global prevalence, incidence, progression, and outcomes of NAFLD and nonalcoholic steatohepatitis (NASH). PubMed/MEDLINE were searched from 1989 to 2015 for terms involving epidemiology and progression of NAFLD. Exclusions included selected groups (studies that exclusively enrolled morbidly obese or diabetics or pediatric) and no data on alcohol consumption or other liver diseases. Incidence of hepatocellular carcinoma (HCC), cirrhosis, overall mortality, and liver-related mortality were determined. NASH required histological diagnosis. All studies were reviewed by three independent investigators. Analysis was stratified by region, diagnostic technique, biopsy indication, and study population. We used random-effects models to provide point estimates (95% confidence interval [CI]) of prevalence, incidence, mortality and incidence rate ratios, and metaregression with subgroup analysis to account for heterogeneity. Of 729 studies, 86 were included with a sample size of 8,515,431 from 22 countries. Global prevalence of NAFLD is 25.24% (95% CI: 22.10-28.65) with highest prevalence in the Middle East and South America and lowest in Africa. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). Fibrosis progression proportion, and mean annual rate of progression in NASH were 40.76% (95% CI: 34.69-47.13) and 0.09 (95% CI: 0.06-0.12). HCC incidence among NAFLD patients was 0.44 per 1,000 person-years (range, 0.29-0.66). Liver-specific mortality and overall mortality among NAFLD and NASH were 0.77 per 1,000 (range, 0.33-1.77) and 11.77 per 1,000 person-years (range, 7.10-19.53) and 15.44 per 1,000 (range, 11.72-20.34) and 25.56 per 1,000 person-years (range, 6.29-103.80). Incidence risk ratios for liver-specific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56).
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            A new definition for metabolic associated fatty liver disease: an international expert consensus statement

            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.
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              MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease

              Fatty liver associated with metabolic dysfunction is common, affects a quarter of the population, and has no approved drug therapy. Although pharmacotherapies are in development, response rates appear modest. The heterogeneous pathogenesis of metabolic fatty liver diseases and inaccuracies in terminology and definitions necessitate a reappraisal of nomenclature to inform clinical trial design and drug development. A group of experts sought to integrate current understanding of patient heterogeneity captured under the acronym nonalcoholic fatty liver disease (NAFLD) and provide suggestions on terminology that more accurately reflects pathogenesis and can help in patient stratification for management. Experts reached consensus that NAFLD does not reflect current knowledge, and metabolic (dysfunction) associated fatty liver disease "MAFLD" was suggested as a more appropriate overarching term. This opens the door for efforts from the research community to update the nomenclature and subphenotype the disease to accelerate the translational path to new treatments.
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                Author and article information

                Journal
                Euroasian J Hepatogastroenterol
                Euroasian J Hepatogastroenterol
                EJOHG
                Euroasian Journal of Hepato-Gastroenterology
                Jaypee Brothers Medical Publishers
                2231-5047
                2231-5128
                July 2022
                : 12
                : Suppl 1
                : S1-S4
                Affiliations
                [1,2 ]Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, Odisha, India
                [3 ]Section of Gastroenterology, Department of Medicine, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
                [4 ]Alka Hospital, Kathmandu, Nepal
                [5 ]Colombo North Centre for Liver Disease, Faculty of Medicine/University of Kelaniya, Colombo, Sri Lanka
                [6 ]Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan
                [7 ]Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
                Author notes
                Shivaram P Singh, Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, Odisha, India, Phone: +91 6712505466, e-mail: spsingh.cuttack@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-7311-4055
                https://orcid.org/0000-0002-8410-4637
                https://orcid.org/0000-0001-5567-3542
                https://orcid.org/0000-0003-3728-3879
                Article
                10.5005/jp-journals-10018-1363
                9681577
                36466103
                404c6d26-24da-49d8-939b-27a375a083c5
                Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.

                © The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Original Article

                nash,nomenclature,patients' sentiments,south asia,steatohepatitis

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