Substantial overlap between NAFLD and MASLD with comparable disease severity and non-invasive test performance: An analysis of the Indian Consortium on MASLD (ICOM-D) cohort

India, currently the most populous country in the world, has a humongous burden of non-alcoholic fatty liver disease (NAFLD) with an estimated pooled prevalence of 38.6% and possible geographic and rural-urban variations ( 1 Shalimar Elhence A. Bansal B. et al. Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis. J Clin Exp Hepatol. 2022; 12: 818-829https://doi.org/10.1016/j.jceh.2021.11.010 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar ). Given the large population of India and the alarmingly high prevalence of NAFLD in the country, it is not an overstatement to suggest that India is home to one of the highest number of patients with NAFLD in the world. Thus, the recent change in nomenclature of NAFLD to metabolic-dysfunction associated steatotic liver disease (MASLD) has huge implications for clinical practice in India ( 2 Rinella M.E. Lazarus J.V. Ratziu V. et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023 Dec; 79: 1542-1556https://doi.org/10.1016/j.jhep.2023.06.003 Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar ). This is further compounded by the recent guidance document by the Indian national Association for Study on Liver (INASL) which was published just prior to the Delphi consensus and had endorsed retaining the nomenclature of NAFLD over metabolic-dysfunction associated fatty liver disease (MAFLD) thereby leading to unnecessary confusion among both clinicians and patients in India ( 3 Duseja A. Singh S.P. De A. et al. Indian National Association for Study of the Liver (INASL) Guidance Paper on Nomenclature, Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD). J Clin Exp Hepatol. 2023; 13: 273-302 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar ). The Indian Consortium on MASLD (ICOM-D), previously known as Indian Consortium on NAFLD (ICON-D), is a real-life, multicentric study which has been ongoing for over 4 years and captures electronic data of NAFLD patients in 40 centres across the length and breadth of India. We assessed the applicability of MASLD criteria in Indian patients with NAFLD and compared the disease severity and performance of non-invasive tests in these patients. 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