Possible NAFLD name change must benefit both patients, field of hepatology
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Regarding the nonalcoholic fatty liver disease nomenclature debate, I am pretty neutral to what the new name should be, and I want to be sensitive to all parties involved.
There are some people who are passionate about changing the name and others who feel it should not change. Whatever we decide to do, it must be helpful to our patients and to the hepatology field. Currently, the No. 1 need our patients have is treatment for nonalcoholic steatohepatitis-related fibrosis. We have FDA and European Medicines Agency guidance that is linked to a particular natural history of disease and diagnosis of NASH stage 2 fibrosis or higher. To me, we should do everything to protect that integrity so we can continue to develop drugs for a particular indication. If it really affects that particular entity who needs to be treated — a patient with NASH stage 2 fibrosis or higher — that will have a major negative impact on the field.
Anything not done with caution can have an impact on the field. It is important to understand all parties, take their views into account and come up with a consensus. That is what people are trying to do in AASLD, EASL and all the other societies, and also stakeholders, patients and their voices. I hope that this process satisfies all parties involved when completed.
There have been considerations on removing “fatty” from NAFLD and changing the term to “steatotic liver disease.” Additionally, there are discussions regarding metabolic dysfunction and associated fatty liver disease and whether we should include those who have alcohol-associated fatty liver into the broader terminology. There are many things that are currently happening. We wish that there were new pathogenetic mechanisms available to really risk-stratify patients based upon that and then change the nomenclature.
Once we really understand the disease states better in the next 5 or 6 years, we may actually have further sub-classifications. We should develop a change in name, though it should not change the history of those who need to be treated [or derail] the drug development or the biomarker development within the broader field of NASH.
- For more information:
- Rohit Loomba, MD, MHSc, is professor of medicine, director of hepatology and the NAFLD Research Center, and vice chief of gastroenterology at the University of California, San Diego.
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