The International Society of Tropical Paediatrics (ISTP) endorses the redefinition of fatty liver disease

Abstract

We read with great interest the article by Dr. Nan and colleagues[1]Nan Y. An J. Bao J. Chen H. Chen Y. Ding H. et al.The Chinese Society of Hepatology position statement on the redefinition of fatty liver disease.J Hepatol. 2021; 75: 454-461Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar which presents the statement of the Chinese Society of Hepatology’s endorsement of the comprehensive proposal for the redefinition of fatty liver disease in adults and children.[2]Eslam M. Newsome P.N. Sarin S.K. Anstee Q.M. Targher G. Romero-Gomez M. et al.A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement.J Hepatol. 2020; 73: 202-209Abstract Full Text Full Text PDF PubMed Scopus (715) Google Scholar,[3]Eslam M. Alkhouri N. Vajro P. Baumann U. Weiss R. Socha P. et al.Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus statement.Lancet Gastroenterol Hepatol. 2021; Abstract Full Text Full Text PDF Scopus (16) Google Scholar In this letter, the International Society of Tropical Paediatrics (ISTP) joins this statement and announces their endorsement of the new term and definition for metabolic dysfunction-associated fatty liver disease (MAFLD). ISTP was founded in 1986 and is an affiliate of the International Paediatric Association (IPA). The primary focus for ISTP is the promotion of paediatric disease knowledge in tropical and sub-tropical countries to help improve the health of children in these regions, which have some of the highest global prevalences of obesity and MAFLD. The former term, non-alcoholic fatty liver disease (NAFLD) was problematic in children, as it does not make any sense to include ‘alcohol’ in the name when conveying information to parents. In addition, NAFLD was defined solely based on the exclusion of other causes of chronic liver disease, with experts raising concerns about the potential risk of over diagnosis and excessive investigations.[4]Kotha S. Berry P. Multiple investigations for a very common disorder: finding the right balance in NAFLD.J Hepatol. 2021; Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In contrast, the new definition of fatty liver disease provides a comprehensive, simple, and practical approach for the diagnosis of fatty liver disease in children and adults and takes into consideration the heterogeneity of fatty liver disease. It provides simple criteria for the diagnosis of MAFLD based on the presence of metabolic dysfunction, that it is intimately implicated in the pathogenesis of fatty liver disease.[5]El-Koofy N.M. Anwar G.M. El-Raziky M.S. El-Hennawy A.M. El-Mougy F.M. El-Karaksy H.M. et al.The association of metabolic syndrome, insulin resistance and non-alcoholic fatty liver disease in overweight/obese children.Saudi J Gastroenterol off J Saudi Gastroenterol Assoc. 2012; 18: 44Crossref PubMed Scopus (52) Google Scholar In addition, it distinguishes MAFLD from fatty liver with other identifiable systemic disorders, including malnutrition and on the other hand brings the attention to the need for further studies to clarify the pathogenic basis of fatty liver without a clear underlying defect. This definition indicates the potential coexistence of more than one cause of chronic liver disease and means that clinicians are not compelled to search for rare causes of fatty liver, but can instead follow their own clinical judgement. The adoption of this change would have strong positive implications in the battle to combat fatty liver disease at numerous levels. The simplicity of the MAFLD criteria, which can be easily incorporated (without extra costs) into standard healthcare packages would improve the detection of this disease, particularly in the primary care setting, and would allow for efficient referral and multidisciplinary management. In conclusion, the ISTP joins the the Chinese Society of Hepatology and considers the new definition of fatty liver disease by Eslam et al. in adults and children a pivotal step in our ongoing efforts to increase the awareness and enhance the prevention and management of MAFLD.[6]Eslam M. Ahmed A. Després J.-P. Jha V. Halford J.C.G. Chieh J.T.W. et al.Incorporating fatty liver disease in multidisciplinary care and novel clinical trial designs for patients with metabolic diseases.Lancet Gastroenterol Hepatol. 2021; Abstract Full Text Full Text PDF Scopus (10) Google Scholar There has been no financial support for this manuscript by any source. All authors contributed to conceptualisation, drafting and revision of the manuscript. The authors have nothing to disclose. Please refer to the accompanying ICMJE disclosure forms for further details. The following are the supplementary data to this article: Download .pdf (.26 MB) Help with pdf files Multimedia component 1 The Chinese Society of Hepatology position statement on the redefinition of fatty liver diseaseJournal of HepatologyVol. 75Issue 2PreviewFatty liver disease associated with metabolic dysfunction is of increasing concern in mainland China, the world’s most populous country. The incidence of fatty liver disease is highest in China, surpassing the incidence in European countries and the USA. An international consensus panel recently published an influential report recommending a novel definition of fatty liver disease associated with metabolic dysfunction. This recommendation includes a switch in name from non-alcoholic fatty liver disease (NAFLD) to metabolic (dysfunction)-associated fatty liver disease (MAFLD) and adoption of a set of positive criteria for disease diagnosis that are independent of alcohol intake or other liver diseases. Full-Text PDF