Indian National Association for Study of the Liver (INASL) Guidance Paper on Nomenclature, Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD).

印度全国肝脏研究协会 （ INASL ） 命名指导文件 ，非酒精性脂肪性肝病 （ NAFLD ） 的诊断和治疗。

• 发表时间: Mar-Apr 2023
• 来源期刊: J Clin Exp Hepatol
• DOI: 10.1016/j.jceh.2022.11.014
• PMID: 36950481
• 文章类型: Journal Article
• 作者列表: Duseja A,Singh SP,De A,Madan K,Rao PN,Shukla A,Choudhuri G,Saigal S,Shalimar ,Arora A,Anand AC,Das A,Kumar A,Eapen CE,Devadas K,Shenoy KT,Panigrahi M,Wadhawan M,Rathi M,Kumar M,Choudhary NS,Saraf N,Nath P,Kar S,Alam S,Shah S,Nijhawan S,Acharya SK,Aggarwal V,Saraswat VA,Chawla YK

关键词: AASLD, American Association for the Study of Liver Diseases; ALD, alcohol-associated liver disease; ALT, alanine aminotransferase; APRI, AST-platelet ratio index; AST, aspartate aminotransferase; BMI, body mass index; CAP, controlled attenuation parameter; CHB, chronic Hepatitis B; CHC, chronic Hepatitis C; CK-18, Cytokeratin-18; CKD, chronic kidney disease; CRN, Clinical Research Network; CVD, cardiovascular disease; DAFLD/DASH, dual etiology fatty liver disease or steatohepatitis; EBMT, endoscopic bariatric metabolic therapy; ELF, enhanced liver fibrosis; FAST, FibroScan-AST; FIB-4, fibrosis-4; FLIP, fatty liver inhibition of progression; FXR, farnesoid X receptor; GLP-1, glucagon-like peptide-1; HCC, hepatocellular carcinoma; INASL, Indian National Association for Study of the Liver; LAI, liver attenuation index; LSM, liver stiffness measurement; MAFLD; MAFLD, metabolic dysfunction-associated fatty liver disease; MR-PDFF, magnetic resonance – proton density fat fraction; MRE, magnetic resonance elastography; MetS, metabolic syndrome; NAFL:, nonalcoholic fatty liver; NAFLD, nonalcoholic fatty liver disease; NAS, NAFLD activity score; NASH; NASH, nonalcoholic steatohepatitis; NCD, noncommunicable diseases; NCPF, noncirrhotic portal fibrosis; NFS, NAFLD fibrosis score; NHL, non-Hodgkin's lymphoma; NPCDCS, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke; OCA, obeticholic acid; PPAR, peroxisome proliferator activated receptor; PTMS, post-transplant metabolic syndrome; SAF, steatosis, activity, and fibrosis; SGLT-2, sodium-glucose cotransporter-2; SWE, shear wave elastography; T2DM, DM: type 2 diabetes mellitus; USG, ultrasound; VAT, visceral adipose tissue; VCTE, vibration controlled transient elastography; fatty liver; hepatic steatosis; nonalcoholic steatohepatitis

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting.

摘要

非酒精性脂肪性肝病（NAFLD）是全球和印度慢性肝病的主要原因。在印度，NAFLD的负担已经很高，预计未来将与肥胖和2型糖尿病的持续流行同时进一步增加。鉴于NAFLD在社区中的高患病率，确定有进展性肝病风险的患者对于简化转诊和指导适当的管理至关重要.各种国际社会关于NAFLD的现有指南未能捕捉到印度NAFLD的整个景观，并且由于印度可用的社会文化方面和卫生基础设施的根本差异，通常难以纳入临床实践。自2015年印度全国NAFLD肝脏研究协会发表初始立场文件以来，NAFLD领域取得了很大进展。Further,关于NAFLD命名法的争论正在引起临床医师的过度混淆.随后的全面审查提供了基于共识的，关于命名法的指导声明，诊断,以及在印度环境中实际上可以实施的NAFLD治疗。