Review

. 2020 Jul;73(1):202-209.

doi: 10.1016/j.jhep.2020.03.039. Epub 2020 Apr 8.

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

Mohammed Eslam¹, Philip N Newsome², Shiv K Sarin³, Quentin M Anstee⁴, Giovanni Targher⁵, Manuel Romero-Gomez⁶, Shira Zelber-Sagi⁷, Vincent Wai-Sun Wong⁸, Jean-François Dufour⁹, Jörn M Schattenberg¹⁰, Takumi Kawaguchi¹¹, Marco Arrese¹², Luca Valenti¹³, Gamal Shiha¹⁴, Claudio Tiribelli¹⁵, Hannele Yki-Järvinen¹⁶, Jian-Gao Fan¹⁷, Henning Grønbæk¹⁸, Yusuf Yilmaz¹⁹, Helena Cortez-Pinto²⁰, Claudia P Oliveira²¹, Pierre Bedossa²², Leon A Adams²³, Ming-Hua Zheng²⁴, Yasser Fouad²⁵, Wah-Kheong Chan²⁶, Nahum Mendez-Sanchez²⁷, Sang Hoon Ahn²⁸, Laurent Castera²⁹, Elisabetta Bugianesi³⁰, Vlad Ratziu³¹, Jacob George³²

Affiliations

¹ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia. Electronic address: mohammed.eslam@sydney.edu.au.
² National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: p.n.newsome@bham.ac.uk.
³ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
⁴ Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
⁵ Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
⁶ UCM Digestive Diseases, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla, CIBEREHD, University of Seville, Sevilla, Spain.
⁷ School of Public Health, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.
⁸ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
⁹ University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland; Department of Biomedical Research, University of Bern, Switzerland.
¹⁰ Department of Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Germany.
¹¹ Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
¹² Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile and Centro de Envejecimiento y Regeneracion (CARE), Departamento de Biologia Celular y Molecular, Facultad de Ciencias Biologicas Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹³ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹⁴ Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
¹⁵ Liver Center, Italian Liver Foundation, Trieste, Italy.
¹⁶ Department of Medicine, University of Helsinki and Helsinki University Hospital, and Minerva Foundation Institute for Medical Research, Helsinki, Finland.
¹⁷ Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China.
¹⁸ Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
¹⁹ Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey; Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
²⁰ Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal.
²¹ Department of Gastroenterology, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
²² Department of Pathology, Physiology and Imaging, Beaujon Hospital Paris Diderot University, Paris, France.
²³ Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Nedlands, WA, Australia.
²⁴ NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
²⁵ Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University Hospitals, Minya, Egypt.
²⁶ Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²⁷ Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
²⁸ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
²⁹ Université Paris VII, Inserm Umr 1149, Centre de Recherche Sur L'inflammation, Paris, France.
³⁰ Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy.
³¹ Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière-, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. Electronic address: vlad.ratziu@inserm.fr.
³² Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia. Electronic address: jacob.george@sydney.edu.au.

PMID: 32278004
DOI: 10.1016/j.jhep.2020.03.039

Free article

Review

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

Mohammed Eslam et al. J Hepatol. 2020 Jul.

Free article

. 2020 Jul;73(1):202-209.

doi: 10.1016/j.jhep.2020.03.039. Epub 2020 Apr 8.

Authors

Affiliations

¹ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia. Electronic address: mohammed.eslam@sydney.edu.au.
² National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, UK; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: p.n.newsome@bham.ac.uk.
³ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
⁴ Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
⁵ Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
⁶ UCM Digestive Diseases, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla, CIBEREHD, University of Seville, Sevilla, Spain.
⁷ School of Public Health, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.
⁸ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
⁹ University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland; Department of Biomedical Research, University of Bern, Switzerland.
¹⁰ Department of Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Germany.
¹¹ Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
¹² Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile and Centro de Envejecimiento y Regeneracion (CARE), Departamento de Biologia Celular y Molecular, Facultad de Ciencias Biologicas Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹³ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹⁴ Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
¹⁵ Liver Center, Italian Liver Foundation, Trieste, Italy.
¹⁶ Department of Medicine, University of Helsinki and Helsinki University Hospital, and Minerva Foundation Institute for Medical Research, Helsinki, Finland.
¹⁷ Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China.
¹⁸ Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
¹⁹ Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey; Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
²⁰ Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal.
²¹ Department of Gastroenterology, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
²² Department of Pathology, Physiology and Imaging, Beaujon Hospital Paris Diderot University, Paris, France.
²³ Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Nedlands, WA, Australia.
²⁴ NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
²⁵ Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University Hospitals, Minya, Egypt.
²⁶ Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²⁷ Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
²⁸ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
²⁹ Université Paris VII, Inserm Umr 1149, Centre de Recherche Sur L'inflammation, Paris, France.
³⁰ Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy.
³¹ Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière-, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. Electronic address: vlad.ratziu@inserm.fr.
³² Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia. Electronic address: jacob.george@sydney.edu.au.

PMID: 32278004
DOI: 10.1016/j.jhep.2020.03.039

Abstract

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.

Keywords: Cirrhosis; Diabetes; Diagnostic criteria; MAFLD; Metabolic; NAFLD; Obesity; Steatohepatitis.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.

Comment in

From NAFLD to MAFLD: when pathophysiology succeeds.
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Reply to: Correspondence on "A new definition for metabolic associated fatty liver disease: an international expert consensus statement": MAFLD: Moving from a concept to practice.
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The times they are a-changin' (for NAFLD as well).
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A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement

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

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