Talk:Metabolic dysfunction–associated steatotic liver disease

re protein kinase
Stuff going on re protein kinase. JFW | T@lk  23:26, 7 March 2007 (UTC)

Epidemiology
, Dr Angulo about the epidemiology of this entity. JFW | T@lk  14:51, 1 April 2007 (UTC)

HRQOL
HRQOL poorer than in chronic viral hepatitis! JFW | T@lk  23:24, 2 July 2007 (UTC)


 * Fatigue, in particular, is quite marked. It is associated with daytime somnolonce but is not worse or better depending on the severity of the NAFLD on biopsy. JFW |  T@lk  21:24, 13 May 2008 (UTC)

Diagnosis and monitoring
(Hepatology review) JFW | T@lk  09:39, 29 July 2007 (UTC)

AASLD
added some information presented at the AASLD annual meeting. Unfortunately, these papers have not yet been printed. I'm just posting a reminder here that we need to trace the studies on PubMed in the future.

Meta-analysis suggests that bariatric surgery improves NASH in 80%: R. Mummadi (University of Texas Medical Branch) - Mummadi R, et al "Effect of Bariatric Surgery on Nonalcoholic Fatty Liver Disease (NAFLD): A meta-analysis" AASLD Meeting 2007; Abstract 130 presented Nov. 5.

I have asked Raja92 to keep an eye out as well. JFW | T@lk  06:04, 25 November 2007 (UTC)
 * The institutional guidelines now recognize bariatric surgery as a possible treatment, but this source gives an estimation of the improvements, it's now added in the article, thank you! --Signimu (talk) 22:06, 2 November 2018 (UTC)

Children
JFW | T@lk  14:36, 6 April 2008 (UTC)

Super size me
Do a Morgan Spurlock, get elevated ALT within a couple of weeks: JFW |  T@lk  05:50, 14 April 2008 (UTC)

Wine
was added. This is a study using the NHANES III dataset where it was demonstrated that unexplained mildly raised ALT was much less likely in people who drink one glass of wine a day. I have no access to the fulltext article, but I can see that this was an observational study that does not seem to have confirmed diagnosis of NAFLD in any way. This casts significant doubts on the choice of endpoint, and makes it a poor choice for a general purpose encyclpedia. JFW | T@lk  05:48, 30 May 2008 (UTC)

Antioxidants
Last submission regarding the benefit ( or lack ) of antioxidants would need to be reworded in Light of Cochrane evaluation below

Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004996. Links Antioxidant supplements for non-alcoholic fatty liver disease and/or steatohepatitis.Lirussi F, Azzalini L, Orando S, Orlando R, Angelico F. University of Padova Medical School, Department of Medical and Surgical Sciences, Via Giustiniani, 2, Padova, Italy. flavio.lirussi@unipd.it

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is characterised by fatty deposition in the hepatocytes of patients with minimal or no alcohol intake and without other known cause. NAFLD includes a wide spectrum of histologic abnormalities ranging from hepatic steatosis to non-alcoholic steatohepatitis (NASH), or even cirrhosis. Antioxidant supplements, therefore, could potentially protect cellular structures against oxidative stress and the resulting lipid peroxidation. OBJECTIVES: To systematically evaluate the beneficial and harmful effects of antioxidant supplements versus no intervention, placebo, or other interventions for patients with NAFLD or NASH. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (June 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2006), MEDLINE (1966 to June 2006), EMBASE (1980 to June 2006), and the Chinese Biomedical Database (1978 to June 2006). No language restrictions were applied. SELECTION CRITERIA: Randomised clinical trials evaluating any antioxidant supplements versus no intervention, placebo, or other interventions in patients with NAFLD or NASH. Our inclusion criteria for NAFLD or NASH were based on history of minimal or no alcohol intake, imaging techniques showing hepatic steatosis, and/or histological evidence of hepatic damage (including simple steatosis, fatty infiltration plus nonspecific inflammation, steatohepatitis, fibrosis, and cirrhosis), and by exclusion of other causes of hepatic steatosis. DATA COLLECTION AND ANALYSIS: We extracted data from the identified trials and contacted authors. We used a random-effects model and fixed-effect model with the significant level set at P = 0.05. We evaluated the methodological quality of the randomised trials by looking at how the generation of allocation sequence, allocation concealment, blinding, and follow-up were performed. We made our analyses following the intention-to-treat method by imputing missing data. MAIN RESULTS: We identified six trials: two were regarded of high methodological quality and four of low methodological quality. None of the trials reported any deaths. Treatment with antioxidant supplements showed a significant, though not clinically relevant, amelioration of aspartate aminotransferase levels, but not of alanine aminotransferase levels, as compared to placebo or other interventions. Gamma-glutamyl-transpeptidase was decreased, albeit not significantly, in the treatment arm. Radiological and histological data were too limited to draw any definite conclusions on the effectiveness of these agents. Adverse events were non-specific and of no major clinical relevance. AUTHORS' CONCLUSIONS: There is insufficient data to either support or refute the use of antioxidant supplements for patients with NAFLD. It may be advisable to carry out large prospective randomised clinical trials on this topic.

PMID: 17253535 [PubMed - indexed for MEDLINE]76.177.138.94 (talk) 17:25, 25 November 2008 (UTC)MJHARD

NAFLD vs NASH
I think the nomenclature is confusing enough as is; the article isn't as clear as it could be in explaining the difference and prognostic implications. I'll try to find some time to work on this Wawot1 (talk) 01:43, 21 January 2010 (UTC)


 * I thought NASH is the most severe form of NAFLD, and the subtype that may progress to fibrosis and cirrhosis. Sadly the terms are often used interchangeably in the workspace. JFW | T@lk  10:11, 21 February 2010 (UTC)
 * Yes exactly as JFW says, this confusion also impacts written articles, although the most recent ones seem to finally have agreed on a consensus (which was helped by institutional guidelines). I added a few sources about this difference. --Signimu (talk) 21:21, 2 November 2018 (UTC)

JCEM on NAFLD as prognostic marker
10.1210/jc.2012-3093 JFW &#124; T@lk  11:33, 1 May 2013 (UTC)

Review
JAMA 10.1001/jama.2015.5370 JFW &#124; T@lk  22:02, 9 June 2015 (UTC)
 * It was added in the article --Signimu (talk) 21:19, 2 November 2018 (UTC)

Why is this a "disease"?
If 20-30% of the US population has it, and the vast majority of people have no symptoms, how can this be called a "disease"? Is having freckles a "disease"? Gnuish (talk) 19:34, 15 September 2015 (UTC)
 * It's because it's an unhealthy condition of the liver that can potentially lead to death Prevalence does not say anything about it being a pathology or not, if prevalence is increasing (as it does now), it only indicates that the causes for developing this pathology are becoming more common/widespread. --Signimu (talk) 21:17, 2 November 2018 (UTC)
 * There are lots of diseases that are very common. Human papillomavirus infection (HPV infection) is extremely common. It's still an infection that can cause disease. Just because something is common (like herpes simplex virus infection or HPV, etc) doesn't mean it isn't a disease. Polio used to be far more common than it is now too, but thankfully we have excellent vaccines that have nearly done away with it and almost snuffed out a scourge of humankind. 170.173.0.22 (talk) 23:10, 21 March 2020 (UTC)

No mention of choline?
I'm surprised to see no mention of choline in this article. Chris Masterjohn did a survey of the literature, and describes the crucial relationship between choline and fatty liver. Could someone less medically challenged than me try to add something about this please? --Brian Fenton (talk) 17:54, 16 December 2015 (UTC)
 * I added something on the topic of choline, in the very interesting context of gut microbiota dysbiosis. Choline supplementation is indeed a regularly administered treatment for animals, but it seems there's not so much literature on humans, but it's rapidly increasing (proof being the reference I found, published in a Nature subjournal ). So the info present now is basic but it will be expanded if(when) there is additional evidence --Signimu (talk) 21:14, 2 November 2018 (UTC)

Sugar-sweetened beverages
10.1093/qjmed/hcv172 JFW &#124; T@lk  13:36, 29 June 2016 (UTC)

Moved
"Foods high in fat and cholesterol, such as meat, dairy, cheese, and oils contribute to non-alcoholic fatty liver disease. A study of 9,000 American adults followed for 13 years showed a strong association between dietary cholesterol intake and hospitalization, and death from cirrhosis and liver cancer. To limit the excess dietary cholesterol, the liver tries to rid itself of cholesterol by dumping it into the bloodstream. Therefore, reducing dietary cholesterol intake, as well as food and beverage high in sugar, one can prevent non-alcoholic fatty liver disease. "

Dies bir appear to support.

-- Doc James (talk · contribs · email) 13:28, 1 September 2016 (UTC)

Risk factor
NASH is an independent risk factor for several other diseases 10.1136/gutjnl-2017-313884 JFW &#124; T@lk  19:43, 14 May 2017 (UTC)

NEJM
10.1056/NEJMra1503519 JFW &#124; T@lk  10:48, 23 November 2017 (UTC)

Issue with references?
Thank you for your message of my talk page, I was not aware of the new content guideline for medical related articles. However, I am surprised of your last revert, could you please explain the reasons why? From my (admittedly quite fresh) understanding of the content guideline, this article, which is a review (it's written on the page, no need to have full access) should be considered a secondary source, isn't it? Thank you for your reply in advance, --Signimu (talk) 17:27, 27 July 2018 (UTC)
 * MEDRS is not new.
 * It would save other people time if you would include the PMID, like the message on your talk page advises.
 * PMID 18824034 is a review but is 9 years old and fails the WP:MEDDATE part of MEDRS
 * PMID 22297845 is a six year old primary source; not a review so fails MEDRS
 * PMID 19293782 is a nine year old primary source. Jytdog (talk) 17:31, 27 July 2018 (UTC)
 * Thank you for your fast reply! Ok I did not know about automatic PMID linking, that's a nice feature! So I am here talking about PMID 18824034. Yes indeed it is old, but I did not find any more recent resource that is more complete, and to my understanding WP:MEDDATE does not prevent the use of "old" reviews if they are not superseeded by newer ones? --Signimu (talk) 17:37, 27 July 2018 (UTC)
 * I will look for a newer source over the weekend. Jytdog (talk) 17:43, 27 July 2018 (UTC)
 * Ok thank you very much! However I suggest we add this review until then, as I am not sure whether a newer review on the pathways exist? But it seems you know the field better so I let you decide about it! --Signimu (talk) 17:46, 27 July 2018 (UTC)
 * There is no deadline here. This has been a very hot field; it would be staggering if there were not a newer source. I have no more time for this today. Jytdog (talk) 17:47, 27 July 2018 (UTC)
 * Ah I did not know it had become a hot field! It's good then, I have been following this topic for years and not much progressed before... Well thank you ! I am going to post here a few more recent reviews I have found:
 * PMID 29300050 is a 2018 Nature review on the pathogenesis so quite good I think but it's quite short (2 pages).
 * PMID 25848481 is from 2015 and longer but not about pathogenesis (predatory journal)
 * is a 2015 review on prevalence (we learn that NASH was the 2nd leading etiology of liver disease in US in 2015), treatments and outcomes.
 * PMID 26663351 is another 2015 review on pathophysiology and diet and weight loss, where we learn that « weight loss is the most effective way to promote liver fat removal. ».
 * PMID 26907882 is a 2016 review about management of NAFLD and NASH where we learn that NAFLD is estimated to affect 30% of USA population becoming the most common cause of liver disease, that NASH is the progressive subtype of NAFLD and some more discussion on the possible treatments.
 * --Signimu (talk) 18:09, 27 July 2018 (UTC)
 * PMID 25848481 is by a predatory publisher (see here). Please disregard it and please be wary of predatory publishers. We do not cite them.Jytdog (talk) 18:21, 27 July 2018 (UTC)
 * Yes good catch! --Signimu (talk) 20:59, 27 July 2018 (UTC)
 * Some additional references:
 * : chronic intermittent hypoxia caused by «obstructive sleep apnoea is associated with an increased risk of NAFLD, NASH and fibrosis. OSAS patients should be screened for the presence and severity of NAFLD.»
 * [NICE] guidance for NAFLD in 2016. They do not recommend the administration of Omega-3 based on high quality evidence from randomized trials, statins can be continued to be consumed unless liver enzyme levels double within 3 months of starting statins, and NAFLD is a risk factor for hypertension, chronic kidney disease, atrial fibrillation, myocardial infarction, ischaemic stroke and death from cardiovascular causes based on very low to low quality evidence from observational studies.
 * The rate of liver cancer associated with NASH is steadily increasing from 2002 to 2012.
 * More to come...
 * --Signimu (talk) 15:09, 28 July 2018 (UTC)
 * Global prevalence of NAFLD is estimated at 24% in 2017, and a substantial proportion of patients are lean ("lean NAFLD") with a lower median survival rate (free of liver transplantation) than in patients who were not lean according to am international cohort study including 483 patients with biopsy-diagnosed NAFLD with a mean follow-up period of over 11 years, and being overweight in childhood and adolescence is associated with increased risk of NAFLD later in life, with adult NAFLD predicted in a 31-year follow-up study by «risk factors during childhood including BMI and plasma insulin levels, male sex, genetic background (that is, PNPLA3 and TM6SF2 variants) and low birth weight, an emerging risk factor for adulthood NAFLD».
 * --Signimu (talk) 18:41, 28 July 2018 (UTC)

have you looked at the box of the very top of this page? It provides a link to recent reviews in pubmed. I don't understand what you are doing here. There are lots of recent reviews. Jytdog (talk) 15:37, 28 July 2018 (UTC)
 * I don't understand what you mean. I am simply trying to increase the amount and quality of information in the article, isn't this what we are supposed to do? If you agree with the quality of these sources, I can do some commits. If not, please explain why? --Signimu (talk) 17:12, 28 July 2018 (UTC)
 * Please note that I do not simply provide references but also what content I think would be interesting to add. I can add these modifications myself if you agree. Per BOLD I should go on directly but I would prefer that we stay/start on the same page first :-) --Signimu (talk) 17:15, 28 July 2018 (UTC)
 * You appear to be grabbing random MEDRS-ish sources and posting them here with some random comments. If your goal is to update this article:
 * there are two very good citations posted above that nobody has used yet.
 * in the article itself:
 * There are "citations needed" tags, that it would be useful to find recent high quality refs for, and add them and update the content if needed
 * There are many old sources here, and whatever the topic of the content sourced from the old refs is, it would be good to find more recent high quality refs covering those topics and update the content, citing the new source.
 * That would be work focused on improving the existing content. Jytdog (talk) 17:45, 28 July 2018 (UTC)
 * Thank you for pointing out these parts, but I disagree that current works should be directed only towards updating what's already in the article without new content. I am currently reviewing the litterature, I am NOT just grabbing some random references and posting them here, I am reading (at least partially, I'm not doing a scientific meta-analysis meh) all of the references I cited above and I try to select the most pertinent and qualitative ones. I am unsure why you would like all modifications to be restrained to what is already present, because for the moment the reasons you put forward are clearly not enough to convince me. I am continuing my readings but when I feel ready I plan on modifying the article (including adding new content), unless you give me a good reason not to do so... --Signimu (talk) 18:14, 28 July 2018 (UTC)
 * I no where said "updating what's already in the article without new content". I did not say that. Jytdog (talk) 18:40, 28 July 2018 (UTC)
 * The existing content is decent in following MEDMOS with respect to the sectioning and the kinds of content that are here; it definitely needs updating, in content and sourcing.  Be sure you read and follow WP:MEDMOS and WP:MEDHOW along with MEDRS. Jytdog (talk) 18:41, 28 July 2018 (UTC)
 * Sorry then I misunderstood you. I will also take into account updating the old references, but it depends on what I find in the reviews of course! ;-) Yes thank you I tried to read them through, I might have missed a point or two though so please feel free to call me on my mistakes if some happen! :-) --Signimu (talk) 18:43, 28 July 2018 (UTC)
 * Thank you very much for cleaning the article! :-D As you might have noticed, I am more of an "adder" than a cleaner because I often feel unsure about removing content... BTW I am mostly done with my modifications, I am just trying to dig up some more official guidelines I think I still have in my tabs and I will be gone ;-) (until more scientific research is done!) --Signimu (talk) 00:55, 29 July 2018 (UTC)
 * You improved the article. Thanks for that. Jytdog (talk) 01:06, 29 July 2018 (UTC)
 * Thank you very much for your help! You saved me countless hours by pointing me at the WP:MEDRS and the citation tool, I would have made a lot less contributions if I had to manually format everything ;-) I think I'm done now! I will just write down what I could not do as a future todo :-) --Signimu (talk) 04:02, 29 July 2018 (UTC)

Pathophysiology, pathogenesis and guidelines
I think there are currently some great resources about the potential mechanisms of NAFLD, but my molecular biology knowledge is not enough to apprehend this material! If someone is feeling more comfortable, please feel free to review these articles and add more infos!
 * PMID 29300050
 * 
 * 

Also I tried to add as much info as I could from the AASLD 2018 guidelines but I am not a physician so any help is appreciated to complete the article with these guidelines ! --Signimu (talk) 04:06, 29 July 2018 (UTC)
 * There is preliminary evidence that intermittent fasting (here Ramadan fasting) may be beneficial for NAFLD . --Signimu (talk) 14:36, 4 August 2018 (UTC)
 * And there is another strong evidence, from an interventional study, that treating obstructive sleep apnea improves NAFLD and metabolic syndrome . --Signimu (talk) 14:48, 4 August 2018 (UTC)
 * Finally, one review investigating recent findings on animals treated with resveratrol . --Signimu (talk) 15:08, 4 August 2018 (UTC)

Resveratrol can kill
We found that for neurological disorders, cardiovascular diseases, and diabetes, the current clinical trials show that resveratrol was well tolerated and beneficially influenced disease biomarkers. However resveratrol had ambiguous and sometimes even detrimental effects in certain types of cancers and in NAFLD. In most of the clinical trials, the major obstacle presented was resveratrol’s poor bioavailability.ref — Preceding unsigned comment added by 2A02:587:4111:400:38E2:9E27:9189:440F (talk) 13:56, 14 August 2018 (UTC)
 * I fixed the formatting and the header is hyperbolic. But the ref is PMID 28989978; that is from Nature Precision Oncology and is not a bad journal; we can use it. Jytdog (talk) 14:19, 14 August 2018 (UTC)
 * It's now added succinctly in the article:, thank you both for the input! --Signimu (talk) 17:20, 2 November 2018 (UTC)

HELP please
Séralini(yeah *that* one) is involved in a 2017 paper [Multiomics reveal non-alcoholic fatty liver disease in rats following chronic exposure to an ultra-low dose of Roundup herbicide. / Mesnage, Robin; Renney, George; Séralini, Gilles-Eric; Ward, Malcolm; Antoniou, Michael N. In: Scientific Reports, Vol. 7, 09.01.2017, p. 39328.] and, of course, it's being seized upon by the usual anti-glyphosate crew. It's hard to debunk this one as it's outside of my wheelhouse and there's a correlation/causation problem since the initial diagnosis of the effect correlates roughly with the introduction of RoundUp and similar. I noted at least one other author is vehemently anti-GMO and that always raises questions for me, particularly in research bias. And yes, I KNOW this is a pay-per-play journal but it's out there and people are citing it. Apologies as ever for my inability to work Wikipedia, I'm rarely here but I know there are people who enjoy this stuff.17:04, 16 September 2018 (UTC) — Preceding unsigned comment added by Smidoid (talk • contribs)


 * Apparently, it was not a well-done study. I have no idea who is citing it, nor why.--Quisqualis (talk) 20:00, 16 September 2018 (UTC)


 * In any case, it's an animal study, so it should be avoid per WP:MEDRS. --Signimu (talk) 19:07, 2 November 2018 (UTC)

Ginger supplement pilot study
Hi, thanks for tracking down the study on ginger supplimentation. The research design is at scholarly rigorous level that satisfies clinicians and practitioners so i’m Impressed to tracked this down. However it’s a pilot study which are used as an indication to whether or not a main study is worthwhile pursuing, and the chosen statistical analysis suits the statistical variables/factors (fun stuff like the types of logistic regression, ANOVA, MANCOVA etc) that the researchers are considering to use. So it sounds like the results of that study have ticked all the boxes to do just that. However in the our WP article it sounds like a main study has been completed. So in cases like this it’s best to state somethin like, “a double blind randomised control polit study resulted in showing___etc, and (if the case is such) a main study is planned” or “underway”.

So I’m encouraging you to go ahead to modify that because it’s your edit and a worthwhile one especially because we know so little about the modifiable factors related to treatment. It just needs qualifying a bit. And hopefully when the main study is completed, you/we can come back and update that point if it proves to be a clinically efficacious treatment. Wow wouldn’t it be great if it turns out that to be just that!

Also the cited link did not lead me to the article, so if you could make that work it would be helpful too! I can help you if you get stuck on stuff, but I’d like to encourage you to go ahead to give it that little bit of spit n polish.

Ultimately contributions like yours, meaning you have the capacity to understand and identify what research utilises the “gold standard” accepted among clinical researchers and which practitioners is valuable to our WP medical articles. It ensures WP medical articles are scholarly rigorous enough for clinicians to refer to when considering how they improve the QoL of their patients, as well as giving access to that level of information to the general lay person (patient). In turn patients and clinicians can potentially communicate better. So that’s why I’ve taken the time to encourage you make this happen even though it might only be a sentence of two, all learns and stands to benefit.

Anyway I hope that helps, and all the best with this and your future endeavours.Cheers, Dr.khatmando (talk) 15:59, 2 November 2018 (UTC)


 * Good stuff . I added a wikilink for pilot study. Mmm yes i’m not sure why I get a deadlink for the citation. I’m not the best at that stuff as I cite from so many different sources I’ve resigned my self to always making that work properly or i’ll just get caught up in a word full of painful code learning...but usually someone with impeccable skills in that error will descend and help out sometime fairly soon. Thanks for your help and contribution I value that. See you around more WP medical articles sometime. All the best, Dr.khatmando (talk) 16:58, 2 November 2018 (UTC)


 * Thank you very much for your feedback! Yes indeed I added quickly this reference as I stumbled upon it totally by chance I now updated the sentence with your advices (I saw you thanked me so I guess what I just did was fine  ). The link and reference was generated by DOI, I have no idea why the link is broken, probably the journal forgot to redirect after reorganizing their website (but for sure it's not on our side!)... BTW I agree with all you said, that's why I worked on this article following a medical conference on the topic, as I found that the article did not reflect the state of the art, and that was a shame for all the current and future patients and their families since this is getting more and more prevalent! Have a nice day!  --Signimu (talk) 17:01, 2 November 2018 (UTC)


 * Hi, I thought that content was included under research. As such can you point out what’s not compliant. We’re trying to encourage people with capacity to comeback to contributing to WP medical articles. At least this is what I understand to be why I was approached to join the editorial board at the Wikijournal of Medicine which is looking to promote this activity on both original research for the journal and new and improved WP articles published through the journal. Correct me if i’ve misunderstood the interplay of purposes here. Or as I have done explain the rational rather than just point to the relevant WP guidelines. You know them better than others so it’s helpful to make this a learning experience rather than just the outright rejection of an contribution made in good faith. This is one of the reasons why we lost so many clinician contributions to WP articles. I’m not trying to put anyone’s nose out of joint here, but i’m advocating  for a Spirit you can see in the above thread here. Your thoughts? Dr.khatmando (talk) 17:21, 2 November 2018 (UTC)
 * If you look at WP:MEDMOS the research section should not be a collection of individual studies (we ~could~ list hundreds there, in exactly this way, right?), but rather describe research trends - what are the questions being asked, where do we stand with them - that sort of thing. Jytdog (talk) 17:34, 2 November 2018 (UTC)
 * Ah ok, I thought a double-blind controlled study would be OK as preliminary research. Thank you for watching and your clarification --Signimu (talk) 18:26, 2 November 2018 (UTC)


 * overall the page is looking good; sourcing looks very solid overall. Thanks for the improvements! Jytdog (talk) 18:22, 2 November 2018 (UTC)
 * Thank you for your help and your patience! :-D --Signimu (talk) 18:26, 2 November 2018 (UTC)

Current hepatology reports
Thank you for watching the article and your modifications. Good catch, thank you for the tip on! Just out of curiosity, how did you find the exact impact factor? I searched but I did not find :-/ BTW thanks to this change I have found other much better and exciting research on the topic! Thank you very much! --Signimu (talk) 17:33, 2 November 2018 (UTC)
 * the journal website. Here is the NLM page btw. Jytdog (talk) 17:35, 2 November 2018 (UTC)
 * Thank you very much! Yes I found the NLM page on MEDRS too (but it's in the footnotes! Not quite obvious to find ). --Signimu (talk) 18:21, 2 November 2018 (UTC)
 * (PS: ahhh it's not in full-text, the impact factor is in a picture, and it's called CiteScore WTF! Thank you very much for yet another tip :-D). --Signimu (talk) 18:24, 2 November 2018 (UTC)

UTC)
 * Yes I agree and I think there’s an eye for what research is rigorous. I was just in another discussion via email about IFs. They’re helpful as a quick indicator of the potential of the article being in a ballpark standart. It just means that when there’s articles that are published in Journals with meh kind of IFs it doesn’t mean the research isn’t top notch. But you really need to read and assess the article from a drawing from a good understanding of research, learnt formally or through other means (I see the human capacity as valid not how you got it)

There’s a class I used to teach this stuff to undergrads students who would rather cr$p in their hands and clap, than get excited about this stuff. And I see it that’s why you guys, and myself when something catches my eye, can make this work. So I appreciate what you do and for the link to the article working for me you provided. I’ll try and come back to have a look at my next round on WP. I appreciate your dedication and commitment here. It’s very encouraging. And I see Jytdog often putting in the good work...I think we’ve discussed stuff before on translation stuff?..mmm...anyway talk again soon. This article is one of the more important onesDr.khatmando (talk) 18:45, 2 November 2018 (UTC)
 * thanks :) The not-MEDLINE indexed thing is a bigger concern.  It is a springer journal so probably not completely crap but when doing the work (which is a lot!) of finding sources and reading a bunch of them to try to understand what "accepted knowledge" is in order to summarize it, one should reach as high as possible at that foundational level... there is enough reviewing of this condition going on, that there is no reason to accept something that has red flags. Jytdog (talk) 18:49, 2 November 2018 (UTC)
 * I agree with you both and thank you both (and even if I often disagree with his/her choices ). For the ginger article, I still think it's reliable in itself, the study seems to be well designed so that says something about the authors experience, and this journal often publishes work on NAFLD so it looks fine to me on a scientific point (but that's just my opinion ), but indeed the fact that it's not indexed on MEDLINE and it has low IF is enough to remove, because also the article is already full of way more reliable sources such as clinical guidelines, so this raises the bar for all future sources I think  In any case, if it's a pertinent research topic, more studies will appear eventually! --Signimu (talk) 19:13, 2 November 2018 (UTC)

Drug trials section removal
Following : WP:CRYSTAL states that « it is appropriate to report discussion and arguments about the prospects for success of future proposals and projects or whether some development will occur, if discussion is properly referenced », and I think what was described in the section was in this ballpark, don't you think? Sure, it's speculation, but it describes what serious systematic reviews think pertinent as future leads of research (and this also describes current trials, which is a fact). I think it's pertinent to describe the notable trials underway, although we don't know their results, don't you think? --Signimu (talk) 19:16, 2 November 2018 (UTC)
 * The drug trials section was also WP:NOTJOURNAL, #6-7. Drugs under study are in early-stage clinical trials far from conclusions or reviews on them, and the resveratrol and microbiota reports are speculation. All these are unencyclopedic, justifying removal. --Zefr (talk) 19:54, 2 November 2018 (UTC)
 * I hardly follow your reasoning on this one. It was never implied anywhere in the content that you removed that the undergoing clinical trials were not early stage or had any conclusion or result, it was a statement of undergoing trial. So if I follow your reasoning, there should be no mention of undergoing clinical trials at all in medical articles? For the microbiota, I reused the source in other sections with expanded information, it was no speculation at all, although it appeared to be (because at the time I didn't want to dig, so I have just put the ref there for another interested contributor to dig it up). The statement on past drug trials showing so far no result is a negative result, but it's far from speculation either, there are several studies demonstrating that as the systematic review used a source shows (and accounting for the fact that negative results are a lot less likely to be published, this is quite significant). BTW I can't see what WP:NOTJOURNAL #6-7 has to do here, the language was accessible, there were drug compounds names but what can we do? The article is already full of technical terms, and it's normal (the most stringent requirement of being accessible to any literate reader pertaining mostly to the lead, not the rest of the article, although I really do try to keep it accessible). --Signimu (talk) 22:18, 2 November 2018 (UTC)
 * BTW, I asked a question on MEDRS about evaluating sources on the number of subjects, I did not mention you so you are free to choose if you want to participate or not --Signimu (talk) 22:22, 2 November 2018 (UTC)

Fasting
Fasting should be watched in the future, as there is evidence this can be an alternative dieting to caloric restriction like the currently advocated mediterranean diet for NAFLD. A systematic review suggested this should be an interesting lead:. Indeed, numerous studies observed impaired fasting glucose (if I understand correctly but it's rarely defined: glucose during non-eating periods = at "rest"?) for NAFLD and NASH patients compared to controls. Furthermore, a recent biological study on rodents found a mechanism that can explain why the fasting glucose and hepatic fat of NAFLD rodents is indeed improved by intermittent fasting. There are currently several clinical trials underway to study this potential diet, and there is in fact already one study that was done in 2014, but it was only published as a conference abstract:. So I think it's only a matter of time for more evidence to appear. --Signimu (talk) 22:36, 2 November 2018 (UTC)

Unrelated: there was a magazine article that was quite on point on NAFLD, although the sources were of course less reliable since it was made in 2014, before several studies that appeared meanwhile:. --Signimu (talk) 23:27, 2 November 2018 (UTC)

No citeneed left!
Hoorah! There is not a single citeneed left in the article Thank you to all the contributors! --Signimu (talk) 23:12, 2 November 2018 (UTC)

Choline
There seems to be very interesting developments about Choline metabolism for NAFLD development and progression:. Future studies on this topic should be watched --Signimu (talk) 03:06, 4 November 2018 (UTC)

More illustrations?
It would be great to have more illustrations in the article, but I'm not sure where to look for them, does someone have any advice? Is there a WP help article about that? --Signimu (talk) 17:03, 7 November 2018 (UTC)

Medications
Metformin does not appear supported? Doc James (talk · contribs · email) 07:09, 8 November 2018 (UTC)
 * Mmm I don't have everything in mind but from what I remember reading, Metformin was thought to be a very interesting medication as it is prescribed for diabetics, which is a very close disease to NAFLD, but in the end I think that all reviews conclude to no real beneficial effects (there are beneficial effects on biological variables like blood based measures, but not on the liver condition). This issue is in fact shared by pretty much all existing medications for NAFLD. --Signimu (talk) 18:52, 21 February 2019 (UTC)
 * Quick update, with the latest guidelines, metformin is advised for NAFLD patients with diabetes, just like for any other diabetic patient, but not for non-diabetic NAFLD. The rationale is that it can help the diabetic, thus reducing indirectly the risks of NAFLD complications, but it does not help directly to improve the liver histology. --Signimu (talk) 15:59, 2 October 2019 (UTC)

Lean NAFLD have similar risks of progression into NASH and benefit from lifestyle interventions
Interesting cohort study reported by : «Lean non-alcoholic fatty liver disease (lean NAFLD): characteristics, metabolic outcomes and risk factors from a 7-year prospective, community cohort study from Sri Lanka», Hepatology International, December 2018.. It suggests that lean NAFLD might have similar risks of progression into NASH as NAFLD associated with obesity. This will be interesting to monitor, to see if other studies reproduce this finding. --Signimu (talk) 18:55, 21 February 2019 (UTC)

Also reported by Hamid, a single-case study of an individual with lean NAFLD, with a lifestyle modification (mostly dietary) proving to be effective: « Can Diet Help Non-Obese Individuals with Non-Alcoholic Fatty Liver Disease (NAFLD)? », Journal of Clinical Medicine, 2017. --Signimu (talk) 19:06, 21 February 2019 (UTC)

Update: with the Asia Pacific work group guidelines (now in the article) which is covering regions with a much higher prevalence of lean nafld than westesn regions, but recommending safe guidelines, we can say that the same recommendations are made for both obese and lean nafld. Signimu (talk) 19:17, 5 October 2019 (UTC)

standard drinks
The section on Signs and symptoms talks of a factor such as alcohol (over 21 standard drinks/week for men and 14 for women), but looking at the referenced page on standard drinks the concept appears to be standardised only locally within a jurisdiction, not globally. The whole sentence has an associated citation from Practice guidance from the American Association for the Study of Liver Diseases, so is it reasonable to assume that this is referring to US standard drinks? If so I think it would make sense to specify that in the article. Hv (talk) 14:12, 25 June 2019 (UTC)
 * Thank you for raising this very interesting point. Honestly I did not think about this possibility, but this makes sense. I will re-read and edit if necessary to clarify. --Signimu (talk) 02:29, 30 September 2019 (UTC)
 * You were right, the info got mixed up and in fact two different thresholds were indicated (USA and UK) without saying who's who. It's now clarified, thank you! --Signimu (talk) 18:52, 1 October 2019 (UTC)

Weight loss interventions work - on surrogate endpoints
10.1001/jamainternmed.2019.2248 JFW &#124; T@lk  19:51, 3 July 2019 (UTC)
 * Thank you!! I will review and add it --Signimu (talk) 02:31, 30 September 2019 (UTC)

Video
I found the amazing video by Osmosis, I did not know them before and I found the video quite accurate (small inaccuracies about the mechanism but it was before the latest evidence, and it's still not fully clarified as it's still mainly hypotheses so...), but I came to learn about the unfortunate history. I however think this video does not have the outlined issues of others, so I would like to keep it as I think it is very informative for the lay public. The small branding does not bother me as I feel like it's normal the author can sign even if it's an openly shareable video, but if someone minds I can edit it to remove it. --Signimu (talk) 23:59, 4 October 2019 (UTC)

Preoperative weight loss, the reason of NASH prevalence variability?
Preoperative weight loss is useful and recommended before bariatric surgery for obese individuals (added the refs in the entry), but it's not always done. A very interesting paper raises the idea that the implementation of preoperative weight loss, which also reduces liver fat, might be the root cause for the variability of NASH prevalence in morbid obesity patients between studies (some studies report as low as 7.3% whereas others as high as 56%). The authors suggest that preoperative dieting, which we know reduces liver fat, also improves the liver condition, and this might not only explain why some studies report a lower rate of NASH (supposed to recommend preoperative dieting to their patients) but could also predict long-term liver condition improvements (and we know already that preoperative weight loss is the best predictor of postoperative/long-term weight loss). This is highly interesting, and may show a specific usage for preoperative weight loss in the case of NAFLD/metabolic syndrome patients. Surely, this issue should be monitored in the future. --Signimu (talk) 01:59, 18 October 2019 (UTC)

Sirt1 role in liver steatosis
A nice article (in french unfortunately) describes how Sirt1, a regulator of metabolism, changes affects liver steatosis and carcinoma in mice models. Would be interesting to see if a review on humans would study Sirt1 levels. --Signimu (talk) 04:40, 1 November 2019 (UTC)

chREBP
"In the recent years, the transcription factor ChREBP has emerged as a major mediator of glucose action on lipogenic genes and as a key determinant of lipid synthesis in vitro. More importantly, this factor has been described to play a central role in hepatic steatosis and insulin resistance physiopathology. Although its implication in human disease has not yet been demonstrated, ChREBP could be an interesting therapeutic target against metabolic syndrome components." --Signimu (talk) 09:16, 2 November 2019 (UTC)

MRI T1 relaxation time to diagnose NAFLD
An interesting new diagnosis method using a standard T1 MRI by quantifying the relaxation time:. I link it here because the license is OK for Wiki Commons, so we could reuse the images, if in the future this becomes an accepted diagnosis method in guidelines --Signimu (talk) 05:58, 8 November 2019 (UTC)

Weight loss image
Hello, thank you for your corrections About the weight loss image, the purpose was to summarize the main take-away of this extensive section (weight loss is the primary treatment and obesity the main risk). Would you agree that this info is pertinent? If the image is not a good fit (it was indeed only illustrative, not informative), I can instead make a graph showing the increase of risk with obesity + the proportion of remission following weight loss, would that be good? --Signimu (talk) 16:12, 20 November 2019 (UTC)
 * An image of risk by BMI would be great. More informative than that. Doc James  (talk · contribs · email) 20:26, 20 November 2019 (UTC)
 * Ok great I'll have a look to do that --Signimu (talk) 21:16, 20 November 2019 (UTC)

Review
10.1210/endrev/bnz009 JFW &#124; T@lk  20:03, 11 February 2020 (UTC)

MASLD
this might be of interest for you guys. Teneab (talk) 08:11, 11 July 2023 (UTC)

Soy milk, chia seeds, and whole grains
So in the management section of the article I think it may be relevant to talk about and cite some of the following studies:

"Whole-grain consumption and its effects on hepatic steatosis and liver enzymes in patients with non-alcoholic fatty liver disease: a randomised controlled clinical trial"

"Effect of soy milk consumption on glycemic status, blood pressure, fibrinogen and malondialdehyde in patients with non-alcoholic fatty liver disease: a randomized controlled trial"

"Chia (Salvia hispanica)-supplemented diet ameliorates non-alcoholic fatty liver disease and its metabolic abnormalities in humans"

Also there seems to be a couple trials on vegan and vegetarian diets:

"Vegan Diet Advice Might Benefit Liver Enzymes in Nonalcoholic Fatty Liver Disease: an Open Observational Pilot Study"

"Effects of lacto-ovo-vegetarian diet vs. standard-weight-loss diet on obese and overweight adults with non-alcoholic fatty liver disease: a randomised clinical trial" Teneab (talk) 11:11, 26 July 2023 (UTC)

Who is this article supposed to help?
The language is too jargon-ridden for a layperson to make use of it, but too imprecise or general for academics or medical personnel, who presumably already know this stuff anyway. For whom are we writing? rowley (talk) 00:28, 28 July 2023 (UTC)

Nomenclature
The generla consensus agreed to change the nomenclature of fatty liver disease alltogether (including NASH). I did an edit (you may see here; https://en.wikipedia.org/w/index.php?title=Non-alcoholic_fatty_liver_disease&oldid=1173742661) including the new changes, but another user undid it claiming that it must match the article's title. While I agree that they must match, the correct solution would be to change the official title and not refusing to update the nomenclature. I ask for help to anyone that knows how to change article names The Previous One (talk) 18:17, 13 October 2023 (UTC)
 * first things first - can you provide a citation about the change in nomenclature?--Gronk Oz (talk) 10:58, 14 October 2023 (UTC)
 * Why has the new name of MASLD been reverted? The citations you need are the references 1, 9 and 10 in the recent versions of the text. Jrfw51 (talk)

Requested move 29 October 2023

 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: moved to Metabolic dysfunction–associated steatotic liver disease (non-admin closure). Jenks24 (talk) 02:26, 6 November 2023 (UTC)

Non-alcoholic fatty liver disease → Metabolic dysfunction-associated steatotic liver disease – This is the new recommended name for the condition Mikael Häggström (talk) 20:04, 29 October 2023 (UTC)
 * No comment on the basic concept, but shouldn't that be per MOS:SUFFIXDASH? —⁠ ⁠BarrelProof (talk) 22:09, 29 October 2023 (UTC)
 * Support The consensus of hepatologists is that NAFLD should be renamed to MASLD (and NASH to MASH) -- see editorial footnote reference . Where reviews and guidelines previously used NAFLD/NASH this should remain in the text. Yes, as above, it looks as if that should be an en dash in Metabolic dysfunction–associated steatotic liver disease.Jrfw51 (talk) 19:22, 30 October 2023 (UTC)
 * Support the name change was agreed by a broad panel of interest groups and it'll almost certainly permeate the literature over the next few years... Also I'm sorry I'm terrible with this kind of thing, but shouldn't it be... a hyphen? "Metabolic dysfuction-associated" is a compound modifier of the type described at MOS:HYPHEN... right? Ajpolino (talk) 21:28, 31 October 2023 (UTC)
 * It's a compound modifier, but the word "associated" is connected with the two-word phrase "Metabolic dysfunction", which has a space in it, so MOS:SUFFIXDASH says it should use an en dash, like "Turks and Caicos–based company" or "pre–World War II aircraft". Some sources don't use that dash convention, but Wikipedia does. —⁠ ⁠BarrelProof (talk) 21:33, 31 October 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Renaming of "society and culture" section
It seems like the content in the Society and culture section is on-topic, notable, and valuable to readers, but it doesn't exactly fit into the usual content of such a section or what is outlined in WP:MEDSECTIONS. However, I'm not very sure of a good alternative - my best idea is Activism but I'm not sure that's good encyclopedic tone. Any other ideas? Just-a-can-of-beans (talk) 18:38, 19 January 2024 (UTC)

MAFLD
This abbreviation is suddenly introduced, but where's the definion of it? Mazarin07 (talk) 09:12, 30 April 2024 (UTC)


 * It was there, but MAFLD has now been replaced by MASLD as the preferred term. I have made many replacements. Please check and update the text as new reviews and guidelines are produced.Jrfw51 (talk) 11:11, 30 April 2024 (UTC)