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Almost identical values of various non-invasive indexes for hepatic fibrosis and steatosis between NAFLD and MASLD in Asia

2024; Elsevier BV; Volume: 80; Issue: 4 Linguagem: Inglês

10.1016/j.jhep.2023.12.030

1600-0641

Masahito Nakano, Machiko Kawaguchi, Takumi Kawaguchi,

Pancreatitis Pathology and Treatment

A multisociety Delphi consensus statement on new fatty liver disease nomenclatureJournal of HepatologyVol. 79Issue 6PreviewThe 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. Full-Text PDF Open Access We read with great interest the article by Rinella et al. published in the Journal of Hepatology.[1]Rinella M.E. Lazarus J.V. Ratziu V. et al.A multi-society Delphi consensus statement on new fatty liver disease nomenclature.J Hepatol. 2023 Jun 20; Google Scholar In 2023, the non-alcoholic fatty liver disease (NAFLD) Nomenclature Consensus Group published a multi-society Delphi consensus statement on new fatty liver disease nomenclature. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease (MASLD).[1]Rinella M.E. Lazarus J.V. Ratziu V. et al.A multi-society Delphi consensus statement on new fatty liver disease nomenclature.J Hepatol. 2023 Jun 20; Google Scholar MASLD is defined as a combination of hepatic steatosis and the presence of at least one of five cardiometabolic risk factors.[1]Rinella M.E. Lazarus J.V. Ratziu V. et al.A multi-society Delphi consensus statement on new fatty liver disease nomenclature.J Hepatol. 2023 Jun 20; Google Scholar MASLD is the most common cause of chronic liver disease and can lead to hepatic fibrosis, which increases the risk of hepatocellular carcinoma and mortality in Asia.[2]Sung H. Ferlay J. Siegel R.L. et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.CA Cancer J Clin. 2021 May; 71: 209-249Crossref PubMed Scopus (46014) Google Scholar It is essential for the diagnosis and staging of MASLD to evaluate hepatic fibrosis and steatosis. Non-invasive tests (NITs) are the most common method of evaluation of NAFLD [3]Bantel H. Schulze-Osthoff K. Non-invasive tests for evaluating treatment response in NAFLD.J Hepatol. 2023 Mar; 78: e101-e102Abstract Full Text Full Text PDF Google Scholar and are alternatives to liver biopsy for the identification of patients with NAFLD at high risk. [4]Boursier J. Hagström H. Ekstedt M. et al.Non-invasive tests accurately stratify patients with NAFLD based on their risk of liver-related events.J Hepatol. 2022 May; 76: 1013-1020Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar To evaluate hepatic fibrosis, NAFLD fibrosis score, fibrosis (FIB)-4 index, aspartate aminotransferase-to-platelet ratio index (APRI), and BARD score are used. [5]Younes R. Caviglia G.P. Govaere O. et al.Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease.J Hepatol. 2021 Oct; 75: 786-794Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar,[6]Vilar-Gomez E. Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers.J Hepatol. 2018 Feb; 68: 305-315Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar Further, to evaluate hepatic steatosis, hepatic steatosis index (HSI), fatty liver index (FLI), and triglyceride and glucose (TyG) index are used. [5]Younes R. Caviglia G.P. Govaere O. et al.Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease.J Hepatol. 2021 Oct; 75: 786-794Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar,[6]Vilar-Gomez E. Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers.J Hepatol. 2018 Feb; 68: 305-315Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar In particular, marked hepatic fibrosis (≥F2) is associated with hepatocarcinogenesis and prognosis.[7]Tsutsumi T. Eslam M. Kawaguchi T. et al.MAFLD better predicts the progression of atherosclerotic cardiovascular risk than NAFLD: Generalized estimating equation approach.Hepatol Res. 2021 Nov; 51: 1115-1128Crossref PubMed Scopus (95) Google Scholar,[8]Tsutsumi T. Kawaguchi T. Nakano D. Torimura T. Atherosclerotic cardiovascular disease in non-metabolic nonalcoholic fatty liver disease.Hepatol Res. 2022 Mar; 52: 317-319Crossref Scopus (2) Google Scholar Hence, it is important to identify patients with advanced hepatic fibrosis efficiently. However, it is unclear whether the NITs for hepatic fibrosis and steatosis used in NAFLD are also useful in MASLD. Therefore, we compared hepatic fibrosis and steatosis using NITs between NAFLD and MASLD in Asia. This study enrolled 1,907 consecutive health checkup examinees from May 2017 to September 2022. Shear wave elastography (SWE) was performed during a routine ultrasound examination, and patients with liver stiffness ≥6.60 kPa were defined as having marked hepatic fibrosis. Of these individuals, 647 patients met the criteria for a diagnosis of NAFLD and 640, for MASLD. Thus, 99% of patients overlapped. Baseline characteristics of patients with NAFLD (n=647) and MASLD (n=640) are summarized in Table 1. Age, the number of women, and body mass index were almost the same between the two groups. Regarding the NITs for hepatic fibrosis, the values and the prevalence of advanced fibrosis were almost the same in SWE, NAFLD fibrosis score, FIB-4 index, APRI, and BARD score. Similarly, as regards NITs for hepatic steatosis, the values and the prevalence of steatosis were almost the same in the HSI, FLI, and TyG index.Table 1Baseline characteristics of patients with NAFLD and MASLDNAFLD (n=647)MASLD (n=640)Median (IQR)Range (min–max)Median (IQR)Range (min–max)Age (Years)53 (46–63)23–8253 (46–63)23–82Sex (Female/Male)62.8%/37.2% (406/241)N/A62.7%/37.3% (401/239)N/ABMI (kg/m2)23.9 (21.6–26.1)15.9–41.123.9 (21.6–26.1)15.9–41.1SWE (kPa)6.66 (4.99–9.83)3.00–43.56.75 (4.99–9.91)3.00–43.5SWE (F0/F1/F2/F3/F4)46.8%/1.6%/14.8%/8.0%/28.8% (303/10/96/52/186)N/A46.5%/1.6%/14.8%/8.0%/29.1% (298/10/95/51/186)N/ANAFLD fibrosis score-1.77 (-2.73–-0.86)-6.03–1.53-1.77 (-2.73–-0.86)-6.03–1.53NAFLD fibrosis score (F0–F2/Indeterminant score/F3–F4)58.7%/38.0%/3.3% (306/198/17)N/A58.6%/38.1%/3.3% (303/197/17)N/AFIB-4 index0.94 (0.70–1.30)0.27–3.390.94 (0.69–1.30)0.27–3.39FIB-4 index (Alternative fibrosis assessment/Advanced fibrosis excluded/Further investigation/Advanced fibrosis likely)2.6%/81.6%/14.9%/0.9% (17/528/96/6)N/A2.5%/81.7%/14.9%/0.9% (16/523/95/6)N/AAPRI0.266 (0.20–0.37)0.05–1.650.266 (0.20–0.37)0.05–1.65APRI (Non-fibrosis/Significant fibrosis/Severe fibrosis/Cirrhosis)97.0%/2.3%/0.6%/0.1% (627/15/4/1)N/A97.0%/2.3%/0.6%/0.1% (620/15/4/1)N/ABARD score (0/1/2/3/4)7.3%/13.7%/31.7%/41.6%/5.7% (47/89/205/269/37)N/A6.9%/13.9%/31.5%/41.9%/5.8% (44/89/202/268/37)N/ABARD score, Risk of advanced fibrosis (Low/High)79.0%/21.0% (511/136)N/A79.2%/20.8% (507/133)N/AHSI32.1 (30.0–34.7)4.68–55.332.1 (30.1–34.7)4.68–55.3HSI, NAFLD positive (Yes/No)15.8%/84.2% (102/545)N/A15.9%/84.1% (102/538)N/AFLI24.6 (11.0–47.4)0.99–95.924.5 (11.0–47.7)0.99–95.9FLI, Fatty liver present (Yes/No)15.6%/84.4% (101/546)N/A15.8%/84.2% (101/539)N/ATyG index4.61 (4.41–4.78)3.95–5.684.60 (4.41–4.79)3.95–5.68TyG index, Insulin resistance (Yes/No)66.1%/33.9% (426/218)N/A65.8%/34.2% (419/218)N/ANote. Data are expressed as median (interquartile range [IQR]), range, or number.AbbreviationsNAFLD, non-alcoholic fatty liver disease; MASLD, metabolic dysfunction-associated steatotic liver disease; N/A, not applicable; BMI, body mass index; SWE, shear wave elastography; FIB-4 index, fibrosis-4 index; APRI, aspartate aminotransferase to platelet ratio index; HSI, hepatic steatosis index; FLI, fatty liver index; TyG index, triglyceride and glucose index. Open table in a new tab Note. Data are expressed as median (interquartile range [IQR]), range, or number. AbbreviationsNAFLD, non-alcoholic fatty liver disease; MASLD, metabolic dysfunction-associated steatotic liver disease; N/A, not applicable; BMI, body mass index; SWE, shear wave elastography; FIB-4 index, fibrosis-4 index; APRI, aspartate aminotransferase to platelet ratio index; HSI, hepatic steatosis index; FLI, fatty liver index; TyG index, triglyceride and glucose index. In conclusion, 99% of patients with NAFLD met the MASLD criteria in Asia. Ratziu et al. pointed out that at least 98.4% of patients in the current NAFLD database would qualify as having MASLD in Europe. [9]Ratziu V. Boursier J. Confirmatory biomarker diagnostic studies are not needed when transitioning from NAFLD to MASLD.J Hepatol. 2023 Aug 3; Abstract Full Text Full Text PDF Scopus (4) Google Scholar Our findings suggest that NITs for hepatic fibrosis and steatosis used in NAFLD are also useful in MASLD in Asia. Therefore, confirmatory studies for NITs are not needed when transitioning from NAFLD to MASLD worldwide. Previous profiles can be used for new studies even after the implementation of the MASLD nomenclature globally. This work was supported by MHLW Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus Program, Grant Number 23FA1013. T.K. received lecture fees from Janssen Pharmaceutical K.K.; Taisho Pharmaceutical Co., Ltd.; Kowa Company, Ltd.; Otsuka Pharmaceutical Co., Ltd.; Eisai Co., Ltd.; ASKA Pharmaceutical Co., Ltd.; AbbVie GK.; and EA Pharma Co., Ltd. M.N. and M.K. have no potential conflicts of interest to declare. Study concept and design: MN and TK. Writing the manuscript: MN and TK. Statistical analysis: MN and MK. Guarantor of article: TK. All authors approved the final version of the article, including the authorship list. We thank Dr. Keisuke Matsunaga (Saga Health Promotion Foundation) for providing health check-up data. We would like to thank Editage (www.editage.jp) for English language editing.