{
  "society": "KASL",
  "version": "2021",
  "publication_date": "2021-12-01",
  "title": "KASL 2021 Clinical Practice Guidelines for NAFLD",
  "status": "published",
  "recommendations": [
    {
      "recommendation_id": "KASL-2021-R01",
      "topic": "definition",
      "text_en": "KASL defines NAFLD as hepatic steatosis without significant alcohol or other liver diseases.",
      "text_kr_summary": "비음주성 지방간을 NAFLD로 정의.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["28714183"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R02",
      "topic": "screening",
      "text_en": "Screen T2DM and metabolic syndrome patients with FIB-4; Asian BMI cutoff 25 kg/m^2.",
      "text_kr_summary": "T2DM·대사증후군에서 FIB-4 선별; 한국인 BMI 25.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["33271056"],
      "related_nits": ["FIB-4"],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R03",
      "topic": "fib4_cutoff",
      "text_en": "FIB-4 < 1.3 low risk; > 2.67 high risk; Korean validation cohort confirms cutoffs.",
      "text_kr_summary": "FIB-4 1.3/2.67; 한국인 검증.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["17326139"],
      "related_nits": ["FIB-4"],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R04",
      "topic": "lsm_cutoff",
      "text_en": "VCTE LSM cutoffs in Korean population: < 8 kPa low risk; >= 12 kPa advanced fibrosis.",
      "text_kr_summary": "한국인 LSM 8/12 kPa.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["32492533"],
      "related_nits": ["LSM"],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R05",
      "topic": "weight_loss",
      "text_en": "Korean adults: weight loss 5-7% improves steatosis; > 10% improves NASH.",
      "text_kr_summary": "한국인 체중감소 5-7% 지방, >10% NASH 호전.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["25865049"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R06",
      "topic": "pioglitazone",
      "text_en": "Pioglitazone may be considered in Korean NASH patients; consider weight gain risk.",
      "text_kr_summary": "한국인 NASH 피오글리타존 고려; 체중증가 주의.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["27322798"],
      "related_nits": [],
      "related_drugs": ["pioglitazone"]
    },
    {
      "recommendation_id": "KASL-2021-R07",
      "topic": "vitamin_e",
      "text_en": "Vitamin E may be considered in non-diabetic Korean adults with biopsy-proven NASH; insurance coverage limited.",
      "text_kr_summary": "비당뇨 한국 NASH 비타민 E 고려; 보험 제한적.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["20218622"],
      "related_nits": [],
      "related_drugs": ["vitamin_e"]
    },
    {
      "recommendation_id": "KASL-2021-R08",
      "topic": "monitoring",
      "text_en": "Annual FIB-4 in T2DM; 2-year intervals in non-diabetic at baseline low risk.",
      "text_kr_summary": "T2DM 매년, 비당뇨 저위험 격년 FIB-4.",
      "strength": "conditional",
      "evidence_grade": "C",
      "cite_pmids": ["33340572"],
      "related_nits": ["FIB-4"],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R09",
      "topic": "hcc_screening",
      "text_en": "HCC surveillance in NAFLD-cirrhosis Korean patients with biannual ultrasound + AFP per Korean NHIS guidance.",
      "text_kr_summary": "NAFLD 간경변 6개월 초음파+AFP (NHIS 가이드).",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["29624699"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "KASL-2021-R10",
      "topic": "alcohol",
      "text_en": "Significant alcohol intake threshold: > 210 g/wk men; > 140 g/wk women (Korean adapted).",
      "text_kr_summary": "유의 음주: 남 210g/주, 여 140g/주.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["28714183"],
      "related_nits": [],
      "related_drugs": []
    }
  ]
}