{
  "society": "KASL",
  "version": "2025_update_draft",
  "publication_date": "2026-04-20",
  "public_consultation_close": "2026-06-15",
  "title": "KASL 2025 update draft: MASLD nomenclature, NIT, and resmetirom",
  "status": "draft_public_consultation",
  "recommendations": [
    {
      "recommendation_id": "KASL-2025-R01",
      "topic": "definition",
      "text_en": "KASL endorses MASLD nomenclature for Korean patients; cardiometabolic criteria adapted using Korean BMI 23/25 and waist circumference 90/85cm (M/F).",
      "text_kr_summary": "KASL MASLD 채택; 한국인 BMI 23/25, 허리둘레 90/85cm.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["37363821", "39501010"],
      "related_nits": [],
      "related_drugs": [],
      "supersedes": ["KASL-2021-R01"]
    },
    {
      "recommendation_id": "KASL-2025-R03",
      "topic": "fib4_cutoff",
      "text_en": "FIB-4 < 1.3 low; > 2.67 high; Korean adults >= 65 use 2.0; second-tier ELF or LSM if indeterminate.",
      "text_kr_summary": "한국인 65세이상 FIB-4 2.0; 중간시 ELF/LSM.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["17326139", "31430416"],
      "related_nits": ["FIB-4", "ELF", "LSM"],
      "related_drugs": [],
      "supersedes": ["KASL-2021-R03"]
    },
    {
      "recommendation_id": "KASL-2025-R04",
      "topic": "lsm_cutoff",
      "text_en": "Korean VCTE LSM: < 8 kPa exclude; 8-15 kPa indeterminate; >= 15 kPa rule in (raised from 12 based on Korean cohort).",
      "text_kr_summary": "한국 LSM rule-in 12->15 kPa.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["32492533", "39501011"],
      "related_nits": ["LSM"],
      "related_drugs": [],
      "supersedes": ["KASL-2021-R04"]
    },
    {
      "recommendation_id": "KASL-2025-R11",
      "topic": "resmetirom",
      "text_en": "Resmetirom may be considered in Korean adults with biopsy-confirmed F2-F3 MASH following MFDS approval; insurance reimbursement to be determined.",
      "text_kr_summary": "한국 F2-F3 MASH에 레스메티롬 고려; MFDS 승인 후, 급여 미정.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["38324483"],
      "related_nits": [],
      "related_drugs": ["resmetirom"]
    },
    {
      "recommendation_id": "KASL-2025-R12",
      "topic": "glp1",
      "text_en": "Semaglutide and tirzepatide recommended in Korean MASLD patients with T2DM/obesity; observe Korean-specific GI tolerability data.",
      "text_kr_summary": "한국 T2DM/비만 MASLD 세마글루타이드·티르제파타이드.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["33185364", "38028023"],
      "related_nits": [],
      "related_drugs": ["semaglutide", "tirzepatide"]
    },
    {
      "recommendation_id": "KASL-2025-R13",
      "topic": "elf_test",
      "text_en": "ELF test introduced as second-tier NIT in Korea; cutoffs 9.8/11.3; reimbursement under MFDS review.",
      "text_kr_summary": "한국 ELF 2차 NIT 도입; 9.8/11.3; 급여 검토.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["27649089"],
      "related_nits": ["ELF"],
      "related_drugs": []
    }
  ]
}