Author information

¹Department of Medical Record, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

²Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.

³Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Southampton, UK.

⁴Department of Internal Medicine, Yonsei University, Seoul, Korea.

⁵Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.

⁶Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

⁷Precision Medicine, Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

⁸Health Analysis and Pandemic Insight Division, Office for National Statistics, London, UK.

⁹Department Bariatric Surgery, CHI Memorial Hospital, Chattanooga, TN, USA.

¹⁰Beth Israel Deaconess Medical Center and Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA.

¹¹Gastroenterology and Hepatology Department, Clinical and Traslational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain.

¹²Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200, Aarhus N, Denmark.

¹³Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.

¹⁴Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.

¹⁵Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, USA.

¹⁶Department of Gastroenterology, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal.

¹⁷School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.

¹⁸Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Center of Hepatitis Research, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.

¹⁹Department of Surgery, Mayo Clinic, Rochester, MN, USA.

²⁰Department of Gastroenterology, Saiseikai Suita Hospital, Suita, Japan.

²¹Department of Medical Records, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

²²Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

²³Department of Infectious Diseases, Peking University First Hospital, Beijing, China.

²⁴Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.

²⁵Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

²⁶Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena (-2023), Modena, Italy.

²⁷Department of Gastroenterology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey.

²⁸Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.

²⁹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

³⁰Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy.

³¹Medical Imaging Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania.

³²Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.

³³Department of Bariatric Surgery, UnityPoint Clinic Weight Loss, West Des Moines, USA.

³⁴Medical Director, Hepatitis B Foundation, Doylestown, PA, USA.

³⁵Department of Endocrinology and Metabolism, Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, China.

³⁶Department of Bariatric Surgery, ELSAN, Clinique Bouchard, Marseille, France.

³⁷Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

³⁸Department of Endocrinology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.

³⁹Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, USA.

⁴⁰Department of Hepatology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.

⁴¹Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.

⁴²Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.

⁴³Cardiology Department, Sahlgrenska Hospital, Gothenburg, Sweden.

⁴⁴Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy.

⁴⁵Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.

⁴⁶Department of Medical Record Statistics, Guizhou Provincial People's Hospital, Guiyang, China.

⁴⁷Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.

⁴⁸Faculty of Health Science, Maimónides University, Buenos Aires, Argentina.

⁴⁹Clinical and Molecular Hepatology, Translational Health Research Center (CENITRES), Maimónides University, Buenos Aires, Argentina.

⁵⁰Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NHC Key Laboratory of Digestive Diseases, Shanghai Research Center of Fatty Liver Disease, Shanghai, China.

⁵¹Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.

⁵²Child Healthcare Center and Child Nutrition Center, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China.

⁵³Department of Medicine, Rutgers New Jersey Medical School, Newark, USA.

⁵⁴Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

⁵⁵Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University Hospitals, Minya, Egypt.

⁵⁶Department of Nephrology, Jiangnan University Medical Center, Wuxi, China.

⁵⁷Department of Nephrology, Wuxi No. 2 People's Hospital, Wuxi, China.

⁵⁸Department of Pediatrics, University of Chieti, Chieti, Italy.

⁵⁹Department of Gastroenterology, Institute of Digestive Diseases of PLA, Cholestatic Liver Diseases Center and Center for Metabolic Dysfunction-Associated Fatty Liver Disease, the First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, China.

⁶⁰Department of Gastrointestinal Surgery, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

⁶¹Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea.

⁶²Department of Medical Record, West China Hospital Affiliated to Sichuan University, Chengdu, China.

⁶³Department of Medicine, Chulalongkorn University, Bangkok, Thailand.

⁶⁴Department of Bariatric Metabolic Surgery, The Second People's Hospital of Qujing, Qujing, China.

⁶⁵Department of Surgery, Queen Mary Hospital and the University of Hong Kong Shenzhen Hospital, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China.

⁶⁶Department of Microbiota Medicine and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.

⁶⁷Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.

⁶⁸Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.

⁶⁹Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.

⁷⁰Department of Cardiology, the Eighth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

⁷¹Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Caserta, Italy.

⁷²Department of Medical Record, China-Japan Friendship Hospital, Beijing, China.

⁷³First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.

⁷⁴Department of Paediatrics, the Affiliated Children's Hospital of Jiangnan University, Wuxi, China.

⁷⁵Programa de Pós-Graduação em Pediatria, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

⁷⁶Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada.

⁷⁷Medical School, University of Western Australia, Perth, Australia.

⁷⁸Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Beijing, China.

⁷⁹Center of Portal Hypertension, Department of Radiology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.

⁸⁰Department of Gastroenterology and Liver Unit, Royal Cornwall Hospitals NHS Trust, University of Exeter, Exeter, England, UK.

⁸¹Hepatology Unit, University Hospital, CHU Bordeaux, Pessac, and INSERM 1312, Bordeaux University, Bordeaux, France.

⁸²Department of Medical Record, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.

⁸³Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan.

⁸⁴Department of Bariatric Surgery, The View Hospital, Doha, Qatar.

⁸⁵Department of Medicine I, University Hospital Aachen, Aachen, Germany.

⁸⁶UCM Digestive Diseases, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain.

⁸⁷Department of Medical Record, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

⁸⁸Department of Medical Record, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

⁸⁹Department of Gastroenterology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.

⁹⁰Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

⁹¹Division of Endocrinology and Diabetes, Medanta the Medicity Hospital, Gurugram, Haryana, India.

⁹²Hepatology Research Unit, Department Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.

⁹³Department of General Surgery, Whittington Hospital, London, UK.

⁹⁴University College London, London, UK.

⁹⁵Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.

⁹⁶Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

⁹⁷Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China.

⁹⁸Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

⁹⁹Humanity and Health Clinical Trial Center, Hong Kong, China.

¹⁰⁰Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.

¹⁰¹Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. zhoujingya@pumch.cn.

¹⁰²Collaborating Center for the WHO Family of International Classifications, Beijing, China. zhoujingya@pumch.cn.

¹⁰³National Center for Quality Control of Medical Records, Beijing, China. zhoujingya@pumch.cn.

¹⁰⁴MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. zhengmh@wmu.edu.cn.

¹⁰⁵Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, Zhejiang, China. zhengmh@wmu.edu.cn.

Abstract

Background: With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) and the publication of the metabolic dysfunction-associated fatty liver disease (MAFLD) nomenclature in 2020, it is important to establish consensus for the coding of MAFLD in ICD-11. This will inform subsequent revisions of ICD-11.

Methods: Using the Qualtrics XM and WJX platforms, questionnaires were sent online to MAFLD-ICD-11 coding collaborators, authors of papers, and relevant association members.

Results: A total of 890 international experts in various fields from 61 countries responded to the survey. We also achieved full coverage of provincial-level administrative regions in China. 77.1% of respondents agreed that MAFLD should be represented in ICD-11 by updating NAFLD, with no significant regional differences (77.3% in Asia and 76.6% in non-Asia, p = 0.819). Over 80% of respondents agreed or somewhat agreed with the need to assign specific codes for progressive stages of MAFLD (i.e. steatohepatitis) (92.2%), MAFLD combined with comorbidities (84.1%), or MAFLD subtypes (i.e., lean, overweight/obese, and diabetic) (86.1%).

Conclusions: This global survey by a collaborative panel of clinical, coding, health management and policy experts, indicates agreement that MAFLD should be coded in ICD-11. The data serves as a foundation for corresponding adjustments in the ICD-11 revision.