{ "society": "AASLD", "version": "2024_amendment", "publication_date": "2024-03-15", "title": "AASLD 2024 Amendment: Resmetirom and MASLD nomenclature update", "status": "published", "recommendations": [ { "recommendation_id": "AASLD-2024-R01", "topic": "definition", "text_en": "Use the term MASLD (metabolic dysfunction-associated steatotic liver disease) replacing NAFLD; requires hepatic steatosis plus at least one cardiometabolic risk factor.", "text_kr_summary": "NAFLD 대신 MASLD 사용; 지방간 + 1개 이상 심대사 위험인자.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["37363821"], "related_nits": [], "related_drugs": [], "supersedes": ["AASLD-2023-R01"] }, { "recommendation_id": "AASLD-2024-R02", "topic": "metald", "text_en": "MetALD describes patients meeting MASLD criteria with moderate alcohol intake (140-350 g/wk women; 210-420 g/wk men).", "text_kr_summary": "MetALD는 MASLD + 중등도 음주.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["37363821"], "related_nits": [], "related_drugs": [] }, { "recommendation_id": "AASLD-2024-R03", "topic": "screening", "text_en": "Patients with type 2 diabetes, obesity, or metabolic syndrome should be screened for MASLD using FIB-4 as initial NIT.", "text_kr_summary": "T2DM, 비만, 대사증후군에서 FIB-4로 MASLD 선별.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["33271056", "31430416"], "related_nits": ["FIB-4"], "related_drugs": [], "supersedes": ["AASLD-2023-R02"] }, { "recommendation_id": "AASLD-2024-R04", "topic": "fib4_cutoff", "text_en": "FIB-4 < 1.3 indicates low risk of advanced fibrosis; FIB-4 > 2.67 indicates high risk; for age >= 65, use FIB-4 >= 2.0 as upper threshold.", "text_kr_summary": "FIB-4: < 1.3 저위험, > 2.67 고위험; 65세 이상은 >=2.0 고위험.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["17326139", "31430416"], "related_nits": ["FIB-4"], "related_drugs": [], "supersedes": ["AASLD-2023-R03"] }, { "recommendation_id": "AASLD-2024-R05", "topic": "lsm_cutoff", "text_en": "VCTE LSM: < 8 kPa rule out advanced fibrosis; >= 8 to < 12 kPa indeterminate; >= 12 kPa rule in advanced fibrosis.", "text_kr_summary": "LSM < 8 배제, 8-12 회색지대, >=12 확진.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["32492532"], "related_nits": ["LSM"], "related_drugs": [], "supersedes": ["AASLD-2023-R04"] }, { "recommendation_id": "AASLD-2024-R06", "topic": "biopsy", "text_en": "Liver biopsy remains gold standard for diagnosing MASH and staging fibrosis when NITs are indeterminate or for clinical trial enrollment.", "text_kr_summary": "MASH 진단·임상시험 등록 시 간생검 표준.", "strength": "strong", "evidence_grade": "A", "cite_pmids": ["29222917"], "related_nits": [], "related_drugs": [], "supersedes": ["AASLD-2023-R05"] }, { "recommendation_id": "AASLD-2024-R07", "topic": "weight_loss", "text_en": "Weight loss of 7-10% via lifestyle modification leads to MASH resolution and fibrosis improvement.", "text_kr_summary": "체중감소 7-10%로 MASH 호전.", "strength": "strong", "evidence_grade": "A", "cite_pmids": ["25865049"], "related_nits": [], "related_drugs": [] }, { "recommendation_id": "AASLD-2024-R08", "topic": "resmetirom", "text_en": "Resmetirom is recommended for adults with biopsy-confirmed MASH and significant fibrosis (F2-F3) without cirrhosis.", "text_kr_summary": "조직검사 확진 MASH F2-F3 (간경변 제외)에 레스메티롬 권고.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["38324483"], "related_nits": [], "related_drugs": ["resmetirom"] }, { "recommendation_id": "AASLD-2024-R09", "topic": "pioglitazone", "text_en": "Pioglitazone may be considered in biopsy-proven MASH with or without diabetes; weigh weight gain and bone fracture risk.", "text_kr_summary": "조직검사 MASH에 피오글리타존 고려; 체중증가·골절 주의.", "strength": "conditional", "evidence_grade": "B", "cite_pmids": ["27322798"], "related_nits": [], "related_drugs": ["pioglitazone"] }, { "recommendation_id": "AASLD-2024-R10", "topic": "vitamin_e", "text_en": "Vitamin E 800 IU/day may be considered in non-diabetic adults with biopsy-proven MASH; long-term safety uncertain.", "text_kr_summary": "비당뇨 MASH 성인 비타민 E 고려; 장기 안전성 불확실.", "strength": "conditional", "evidence_grade": "B", "cite_pmids": ["20218622"], "related_nits": [], "related_drugs": ["vitamin_e"] }, { "recommendation_id": "AASLD-2024-R11", "topic": "glp1", "text_en": "GLP-1 receptor agonists (semaglutide, tirzepatide) recommended for obesity/T2DM patients with MASLD; emerging evidence in MASH resolution.", "text_kr_summary": "비만/T2DM 동반 MASLD에 GLP-1 RA 권고.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["33185364", "38028023"], "related_nits": [], "related_drugs": ["semaglutide", "tirzepatide"] }, { "recommendation_id": "AASLD-2024-R12", "topic": "monitoring", "text_en": "MASLD patients should undergo NIT every 1-3 years based on baseline FIB-4 risk stratification.", "text_kr_summary": "MASLD 환자 위험도별 1-3년마다 NIT 재평가.", "strength": "conditional", "evidence_grade": "C", "cite_pmids": ["33340572"], "related_nits": ["FIB-4", "LSM"], "related_drugs": [] }, { "recommendation_id": "AASLD-2024-R13", "topic": "hcc_screening", "text_en": "HCC surveillance with biannual ultrasound +/- AFP in MASLD-cirrhosis; consider MRI in high-risk patients with poor US window (obesity).", "text_kr_summary": "MASLD 간경변 6개월 초음파+/-AFP; 고위험·비만 시 MRI 고려.", "strength": "strong", "evidence_grade": "B", "cite_pmids": ["29624699"], "related_nits": [], "related_drugs": [] }, { "recommendation_id": "AASLD-2024-R14", "topic": "fast_score", "text_en": "FAST score < 0.35 rules out at-risk MASH; > 0.67 rules in; useful for clinical trial pre-screening.", "text_kr_summary": "FAST < 0.35 배제, > 0.67 확진; 임상시험 선별에 유용.", "strength": "conditional", "evidence_grade": "B", "cite_pmids": ["32178492"], "related_nits": ["FAST"], "related_drugs": [] }, { "recommendation_id": "AASLD-2024-R15", "topic": "mast_score", "text_en": "MAST score (MRI-PDFF, MRE, AST composite) >= 0.165 identifies at-risk MASH; supports trial enrollment.", "text_kr_summary": "MAST >= 0.165 고위험 MASH 식별.", "strength": "conditional", "evidence_grade": "B", "cite_pmids": ["32294530"], "related_nits": ["MAST"], "related_drugs": [] } ] }