{
  "society": "AASLD",
  "version": "2026_revision_draft",
  "publication_date": "2026-04-15",
  "public_consultation_close": "2026-06-01",
  "title": "AASLD 2026 Revision Draft: MASLD Practice Guidance update",
  "status": "draft_public_consultation",
  "recommendations": [
    {
      "recommendation_id": "AASLD-2026-R01",
      "topic": "definition",
      "text_en": "Use the term MASLD; cardiometabolic criteria include BMI, waist circumference (race/region-specific cutoffs), HbA1c, blood pressure, lipids.",
      "text_kr_summary": "MASLD 정의 유지; 인종별 허리둘레 cutoff 적용.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["37363821"],
      "related_nits": [],
      "related_drugs": [],
      "supersedes": ["AASLD-2024-R01"]
    },
    {
      "recommendation_id": "AASLD-2026-R03",
      "topic": "screening",
      "text_en": "All adults with T2DM, obesity (BMI >= 25 in Asian populations), pre-diabetes, or >= 1 cardiometabolic risk factor should be screened with FIB-4.",
      "text_kr_summary": "T2DM·비만(아시아 BMI>=25)·전당뇨·심대사 위험인자 1개 이상 시 FIB-4 선별.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["33271056", "31430416", "39501010"],
      "related_nits": ["FIB-4"],
      "related_drugs": [],
      "supersedes": ["AASLD-2024-R03"]
    },
    {
      "recommendation_id": "AASLD-2026-R04",
      "topic": "fib4_cutoff",
      "text_en": "FIB-4: < 1.3 low risk; >= 1.3 to <= 2.67 indeterminate (consider second-tier NIT); > 2.67 high risk; age-adjusted thresholds for >= 65 yr (>= 2.0).",
      "text_kr_summary": "FIB-4 layered cutoff 유지; 65세 이상 2.0.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["17326139", "31430416"],
      "related_nits": ["FIB-4"],
      "related_drugs": [],
      "supersedes": ["AASLD-2024-R04"]
    },
    {
      "recommendation_id": "AASLD-2026-R05",
      "topic": "lsm_cutoff",
      "text_en": "VCTE LSM: < 8 kPa rule out; 8-15 kPa indeterminate (consider MRE/ELF); >= 15 kPa rule in advanced fibrosis (raised from 12).",
      "text_kr_summary": "LSM rule-in cutoff 12 -> 15 kPa로 상향, 회색지대 8-15.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["32492532", "39501011"],
      "related_nits": ["LSM"],
      "related_drugs": [],
      "supersedes": ["AASLD-2024-R05"]
    },
    {
      "recommendation_id": "AASLD-2026-R08",
      "topic": "resmetirom",
      "text_en": "Resmetirom is recommended for adults with non-cirrhotic MASH and F2-F3 fibrosis; treatment monitoring with NIT (FIB-4, LSM, MRI-PDFF) every 6 months.",
      "text_kr_summary": "비간경변 MASH F2-F3 레스메티롬; NIT 6개월 모니터링.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["38324483", "39501012"],
      "related_nits": ["FIB-4", "LSM", "PDFF"],
      "related_drugs": ["resmetirom"],
      "supersedes": ["AASLD-2024-R08"]
    },
    {
      "recommendation_id": "AASLD-2026-R16",
      "topic": "pegozafermin",
      "text_en": "Pegozafermin may be considered in F2-F3 MASH per phase 3 ENLIVEN-2 results pending FDA review.",
      "text_kr_summary": "페고자페르민 F2-F3 MASH 고려 (FDA 심사 중).",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["37195353"],
      "related_nits": [],
      "related_drugs": ["pegozafermin"]
    },
    {
      "recommendation_id": "AASLD-2026-R17",
      "topic": "efruxifermin",
      "text_en": "Efruxifermin under evaluation in MASH cirrhosis (F4 compensated); not yet recommended pending phase 3 data.",
      "text_kr_summary": "에프룩시페르민 보상성 간경변 평가 중; 정식 권고 아님.",
      "strength": "weak",
      "evidence_grade": "C",
      "cite_pmids": ["37195355"],
      "related_nits": [],
      "related_drugs": ["efruxifermin"]
    },
    {
      "recommendation_id": "AASLD-2026-R18",
      "topic": "survodutide",
      "text_en": "Survodutide (GLP-1/glucagon co-agonist) phase 2 data show MASH resolution; phase 3 awaited.",
      "text_kr_summary": "수르보두타이드 phase 2에서 MASH 호전; phase 3 대기.",
      "strength": "weak",
      "evidence_grade": "C",
      "cite_pmids": ["38924754"],
      "related_nits": [],
      "related_drugs": ["survodutide"]
    },
    {
      "recommendation_id": "AASLD-2026-R11",
      "topic": "glp1",
      "text_en": "GLP-1 RA and dual/triple agonists (semaglutide, tirzepatide, retatrutide) are recommended for MASLD with obesity/T2DM; emerging MASH histologic benefit.",
      "text_kr_summary": "MASLD+비만/T2DM에 GLP-1 RA 및 dual/triple agonist 권고.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["33185364", "38028023", "39501013"],
      "related_nits": [],
      "related_drugs": ["semaglutide", "tirzepatide", "retatrutide"],
      "supersedes": ["AASLD-2024-R11"]
    },
    {
      "recommendation_id": "AASLD-2026-R19",
      "topic": "elf_test",
      "text_en": "ELF test < 9.8 rules out advanced fibrosis; >= 11.3 rules in; useful as second-tier NIT.",
      "text_kr_summary": "ELF < 9.8 배제, >= 11.3 확진; 2차 NIT.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["27649089"],
      "related_nits": ["ELF"],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2026-R20",
      "topic": "mefib_score",
      "text_en": "MEFIB index (MRE >= 3.3 + FIB-4 >= 1.6) identifies significant fibrosis; useful where MRE available.",
      "text_kr_summary": "MEFIB (MRE>=3.3 + FIB-4>=1.6) 유의 섬유화 식별.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["33002420"],
      "related_nits": ["MEFIB", "MRE", "FIB-4"],
      "related_drugs": []
    }
  ]
}