The former Metabolic and Fatty Liver Clinic at the University of Chicago Medicine has a new name that’s more than just a sign.
Clinic Director Mary E. Rinella, M.D., spearheaded a multiyear process to change the nomenclature (recognized characteristics) surrounding the disease around the world.
The new terminology removes derogatory language, accurately describes the symptoms, and identifies subgroups of patients excluded by previous diagnostic criteria, said Dr. McConlogue, a board-certified transplant liver specialist and professor at the University of Chicago Pritzker School of Medicine. Rinella said.
A new neutral name under consideration is Metabolic Liver Clinic. Although the changes are subtle, they reflect a shift in the way clinicians and patients approach this disease, which affects up to 30% of adults worldwide.
No more “fat”
Most members of the 236-member multinational panel of clinicians, patients, public health and regulatory representatives agreed that the term has the potential to create bias, and that the term has been used for many years and is problematic. The term “non-alcoholic fatty liver disease” is no longer used. But Rinella said that’s not the only reason for his dissatisfaction with the label.
“Non-alcoholic liver disease is a diagnosis of exclusion,” she says. “You’re saying it’s not alcohol. ‘It’s not alcohol, but what is alcohol?’
The answer is, it’s a metabolic disease. Fat accumulates in liver cells, causing inflammation and scarring, which can lead to liver cancer and the need for a transplant.
That’s why the new name for non-alcoholic fatty liver disease, “Metabolic Dysfunction-Associated Fatty Liver Disease” (MASLD), reflects what underlies the disease and changes the conversation we have with patients. Yes, Rinella said.
“This speaks to the abnormal metabolism that causes this liver disease,” she said. “It leads to understanding how we got there in the first place.”
Rinella said people with diabetes, obesity, high blood pressure and high cholesterol are at higher risk, but the disease may be asymptomatic and undiagnosed.
Patients sometimes come to her clinic after an ultrasound, CT scan, or blood test reveals a disease. A screening tool known as FIB-4 helps identify liver disease and is recommended for at-risk people, especially people with diabetes.
“If you catch it early, it can be reversed. The problem is that it goes unnoticed, and people end up with severe symptoms, cirrhosis of the liver, cancer,” Rinella said.
new name alphabet
MASLD is part of a new neutrally named group announced at the European Association for the Study of the Liver (EASL) conference in June.This news was published at the same time Hepatology, Hepatology Journal and Liver Annual Reporton behalf of the American Association for the Study of Liver Diseases, EASL, Switzerland, and the Latin American Association of America (ALEH).
According to Rinella, fatty liver disease is an umbrella term for liver disease due to metabolic or alcohol-related causes.
The new category “MetALD” is aimed at patients with metabolic liver disease who consume moderate amounts of alcohol, and serves as a bridge between MASLD and alcohol-related liver disease.
Previously, such patients would have been excluded from clinical trials for MASLD, “meaning we might not understand how they would respond to treatment,” Rinella said.
“Research efforts have already begun to target that patient population because there are indeed drugs that work well in that patient population,” she said.
global change
The nomenclature development initiative led by Rinella was born after an alternative name for the current MASLD was proposed. The term Fatty Liver Disease Associated with Metabolic Dysfunction (MAFLD) has begun to gain traction, but the term “very serious” problem has been set by setting stricter metabolic standards and allowing the concomitant use of alcohol. But, Rinella said.
As a result, MAFLD has defined a different patient population than the standard group that has been the basis for decades of research, she said.
Although MASLD provides a positive definition, it maintains alcohol use restrictions and is broad enough to have almost complete overlap with NAFLD for patient populations, Rinella said. The new MetALD category “allows us to assess and address the disease course of this important population,” Rinella said.
The naming convention initiative was built around transparency and consensus using a Delphi process (using the collective input of panel members).
“We did this to bring all the parties together and try to reach common ground,” Rinella said.
The work is still incomplete. Rinella said one of the challenges will be changing billing codes not just in the U.S. but around the world.
Rinella said organizations large and small need to make the transition in a way that avoids confusing patients and losing identity and referrals, but that discussion is finalizing the new clinic name at the University of Chicago School of Medicine. It is said that this will be carried out before the
“It just takes time,” Rinella said.
The new terminology “has been very well received,” she said. “It actually worked surprisingly well. It’s used all over the world.”
