Talk:Metabolic dysfunction–associated steatotic liver disease/GA1

GA Review

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Reviewer: Ajpolino (talk · contribs) 04:56, 11 February 2020 (UTC)

I'll take this review on. I'm no liver expert, so give me about a week to get through the article. I'll place my comments below. Feel free to mark addressed comments as {{done}} or strike through them. Sorry for the immensely long wait in the GAN queue. If you need extra time to get back to this article, just let me know. We're in no rush here. Looking forward to the read! Ajpolino (talk) 04:56, 11 February 2020 (UTC)

@Signimu: Ok I've finished my first pass through the article. In general, it looks good and is near to meeting the GA criteria. My biggest concern is that right now the prose is scattered and hard-to-follow in some places. I'd suggest taking a look through, and making sure each paragraph has a purpose. Rearrange sentences/paragraphs within sections as needed to maintain a logical flow. In particular, many sections end with a collection of one-sentence paragraphs that seem to state extra factoids; integrating these into the section will improve the flow and readability of the article. I also had some minor comments, which I've posted below. If you need more time or need a hand addressing these issues, let me know (we're in no rush, and I'm sure we can find more helping hands if need be). It's great to see all the work that has gone into this article! I hope all is well. Ajpolino (talk) 18:23, 13 February 2020 (UTC)

I'll pick this up since this appears to have stalled a bit. TylerDurden8823 (talk) 16:29, 20 March 2020 (UTC)

I'll have to put this on hold for a while since I don't have access to library materials right now unless someone can help me access them in the interim period. TylerDurden8823 (talk) 01:07, 31 March 2020 (UTC)

@TylerDurden8823: If you're still interested, I can probably get you access to most material. Just send me an email with whatever you need. Ajpolino (talk) 02:14, 31 March 2020 (UTC)

@Ajpolino:, I have addressed all of the points you raised except one. You've got mail. TylerDurden8823 (talk) 19:23, 31 March 2020 (UTC)

@TylerDurden8823: Apologies for the long wait. I'll be able to get to this sometime this week. I'm glad to see all the work that has gone into this article! Ajpolino (talk) 16:07, 13 April 2020 (UTC)

Alright, final stretch. I'll leave comments below as I get to them to avoid things getting too spread out and confusing:

• Signs & symptoms - I moved stuff around a bit, hoping to make things more clear. The article says NAFLD can cause symptoms related to liver dysfunction. can we expand on this? It won't be clear to a non-physician what those symptoms would be. I moved the sentence that was at the end of the section up there, assuming those were symptoms of liver dysfunction, but if that's wrong you'll have to fix it (sorry!). Also I added a few words on NASH with wikilinks since I assume it can present with more symptoms once folks have progressed to cirrhosis, et al. Feel free to expand.

 Done These signs/symptoms are already there. I just linked the sentences for clarity. TylerDurden8823 (talk) 08:37, 15 April 2020 (UTC)

• Everywhere - There are several places in the article where text is phrased as clinical advice (e.g. "alternate causes such as alcohol should be investigated."). I'm trying to rephrase them as I go through. If I miss any, please rephrase (per WP:NOTJOURNAL).

 Done I have addressed this the best I could. There are only a few instances of "should" left and I emailed you about needing access to the Asia Pacific Working Group guidelines so I can clarify a few things before addressing the last few remaining instances. TylerDurden8823 (talk) 08:37, 15 April 2020 (UTC)

• Risk factors>Dysbiosis - Can you expand this at all? The last sentence of this cites four fairly recent reviews on the microbiome and NAFLD. Hard to believe there's only two sentences to be gleaned from them.

I could but I don't know that it's really warranted. This is an area of research that is really still in its infancy and has not been studied extensively in humans at this point according to the supporting references. TylerDurden8823 (talk) 20:20, 15 April 2020 (UTC)

Fair enough. Thanks for looking into it. Ajpolino (talk) 01:14, 17 April 2020 (UTC)

• Pathophysiology - Sorry I had an edit window open for a long time attempting to clarify this section and have it flow more clearly. Unfortunately that led to an edit conflict. I tried to merge our changes as best I could, but I may have unintentionally undone some changes you made. Please feel free to remake them, and I'll take any deserved reprimand. I hope the insulin-resistance subsection flows a bit better now? I really like this sentence The three sources of free fatty acids that contribute to liver triglyceride accumulation include FFAs circulating in the bloodstream (59%), FFAs derived from carbohydrate such as fructose and glucose (26%), and diet (14%). from the Marjot review, but I couldn't figure out where to put it. It's sitting alone at the end of the subsection for now.

 Done I've looked through it again and agree with most of the changes. I reworded things a little bit and rearranged things a little more for flow including the sentence you mentioned. There's no reprimand here. I'm in the midst of going through and copyediting the article some and you just happened to beat me to that section. FWIW, I think you made some nice revisions and distilled some of the points I was trying to make from my first/second revisions of that section. Writing is a process and it doesn't always come out perfect on my first or second attempt. TylerDurden8823 (talk) 03:31, 17 April 2020 (UTC)

• Diagnosis - For young people, experts recommend liver ultrasonography, but biopsy remains the best evidence. Could you clarify who "experts" are here? It's one of the classic weasel words examples. Thanks for fixing so many of the other unsupport attributions! It's much improved.

 Done I adjusted this to say "guidelines" instead of experts. I felt it was relatively clear since multiple guidelines are cited at the end of that sentence but I don't feel strongly about it. I only added the word experts in last night in an attempt to write the sentence in an active voice. TylerDurden8823 (talk) 18:23, 17 April 2020 (UTC)

• Diagnosis - also which is recommended for some clinical situations such as people with known intra-hepatic lesions - though if this liver biopsy paragraph isn't specific to NAFLD diagnosis, it could just be merged into Liver biopsy instead...

I don't feel strongly about keeping it. I get why Signimu put it in-they're doing a deeper dive on considerations for one liver biopsy approach over another for people with NAFLD. These principles like do apply for other liver conditions where a biopsy is necessary too, but I don't see that as a big drawback for the liver section. With that said, if you want to remove it to avoid a bloated section, I wouldn't object. TylerDurden8823 (talk) 18:33, 17 April 2020 (UTC)

• Diagnosis - Last paragraph of the section, same thing. I assume the "is not recommended", et al. are from the APASL source at the end?

I'll need to look at the APASL source to verify. I don't have access. TylerDurden8823 (talk) 18:33, 17 April 2020 (UTC)

 Done I have confirmed this is attributed to the APASL reference and adjusted the wording to say that it's contraindicated in those who are uncooperative per the reference. TylerDurden8823 (talk) 18:48, 17 April 2020 (UTC)

• Epidemiology - This section needs a bit of organizational work to bring together related sentences and mini-paragraphs.

 Done TylerDurden8823 (talk) 18:44, 17 April 2020 (UTC)

Otherwise, everything looks great! Kudos in particular for the Research and Society and culture sections, which can sometimes be dumping grounds for random primary studies, but here are excellent, informative, and concise. Thanks again for all of your work on this! It's been excellent to see the article coming together. Ajpolino (talk) 17:54, 17 April 2020 (UTC)

I can't take credit for that part. I didn't really change too much in those sections so that was pretty much all Signimu. TylerDurden8823 (talk) 18:46, 17 April 2020 (UTC)

Excellent! Passing the article now. Sorry this took me so long to get through. It was a pleasure to read and see improved. A gold star to you for jumping in to complete the review. Ajpolino (talk) 19:16, 17 April 2020 (UTC)

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose, spelling, and grammar): b (MoS for lead, layout, word choice, fiction, and lists):

   •Pathophysiology - Is there a reasonable wikilink or short explanation for "portal inflammation"?

    Done There's no clear wikilink I see but I have added a very short explanation for a bit more clarity. TylerDurden8823 (talk) 01:10, 31 March 2020 (UTC)

   •Diagnosis>Blood tests - Is there a wikilink or short explanation for "AST platelet ratio index"?

    Done-I've adjusted this. Hopefully this is clearer even if it's slightly more verbose. TylerDurden8823 (talk) 16:41, 20 March 2020 (UTC)

   •Diagnosis>Imaging - same question but for "narrow intercostal spaces"

    Done-I've adjusted this. There's no wikilink but I've added a short explanation that this is referring to the space between the ribs for clarity. TylerDurden8823 (talk) 16:41, 20 March 2020 (UTC)

   •Diagnosis>Liver biopsy - same question: what's VCTE and what's "the FLIP algorithm"?

    Done I cannot find the term VCTE in the article. I have elaborated a bit more on what the FLIP algorithm is. TylerDurden8823 (talk) 01:16, 31 March 2020 (UTC)

   •Diagnosis>Liver biopsy - the last paragraph in the section seems to fit with the second paragraph. Could you merge the two?

    Done TylerDurden8823 (talk) 16:48, 20 March 2020 (UTC)

   •Management>Diet - "For the EASL, there are no liver-related limitations to the consumption of coffee." sounds a bit weird. Surely there are many things that the EASL (and other groups) don't suggest limiting. Why mention only coffee? Did other groups suggest limiting coffee? If so, a sentence or two on that might help.

    Done-I've adjusted this. I think Signimu specifically mentioned coffee because it is specifically mentioned by EASL's guidelines as a standalone thing. And it actually does word it in the way you quoted. But, I don't think we should lift that sentence exactly as it is from the guideline so I've adjusted it and added a few other sources. I have not found any clear sources indicating that other guidelines specifically recommended against coffee consumption or endorsed limiting consumption for the purposes of helping NAFLD. If anything, the data appears to suggest possible beneficial effects. TylerDurden8823 (talk) 17:20, 20 March 2020 (UTC)

   •Management>Physical activity - "Weight loss may improve the process..." Please clarify. What process?

    Done I think Signimu just meant it improves NAFLD. Clarified. TylerDurden8823 (talk) 01:19, 31 March 2020 (UTC)

   •Outcomes - the first paragraph seems like it doesn't belong here. A "Causes" section would be the obvious place but there isn't one. I'd vote you either find another home for it, or just remove it completely since it doesn't really have any information in it.

    Done-I have moved this to the beginning of the pathophysiology section, which seems like a more fitting place for this bit. TylerDurden8823 (talk) 17:27, 20 March 2020 (UTC)

   •Outcomes - "The progression rate of fibrosis in humans..." It's not clear what progression rate means here. From diagnosis to fibrosis? From symptom onset to fibrosis? From one stage of fibrosis to another? Some clarification would help.

    Done It's from one stage of liver fibrosis to the next stage. I clarified this in the text. TylerDurden8823 (talk) 07:03, 31 March 2020 (UTC)

   •Outcomes - increased risk of death from cardiovascular disease is discussed in two different places in the section. It'd be clearer if you brought them together.

    Done TylerDurden8823 (talk) 17:34, 20 March 2020 (UTC)

2. It is factually accurate and verifiable.

   a (reference section): b (citations to reliable sources): c (OR): d (copyvio and plagiarism):

   •Lead - In the last paragraph you have separate claims that 75-100 million Americans and then 12 to 25% of Americans are affected by NAFLD. Those don't seem to be quite the same (12% to 25% of Americans would be ~39mil to ~82mil Americans). Could you clarify? If sources differ perhaps you could pick some kind of consensus number for the lead and discuss in the article proper?

    Done This has been addressed. TylerDurden8823 (talk) 07:06, 31 March 2020 (UTC)

   •Right now Vitamin E is mentioned both in the Management>Diet section and the Management>Medication section, and they don't quite match up. Perhaps you could pick one of those two places to fully discuss vitamin E?

    Done This has been adjusted. TylerDurden8823 (talk) 07:22, 31 March 2020 (UTC)

   •Same as above, but for omega-3 fatty acids

    Done This has been adjusted. TylerDurden8823 (talk) 07:22, 31 March 2020 (UTC)

3. It is broad in its coverage.

   a (major aspects): b (focused):

   •A discussion of the causes of the disease (i.e. how does obesity and other metabolic problems result in fat deposition, and why does this result in disease?) would certainly improve the article, but is probably not required to pass the "Broad" criteria of GAC.

   @Ajpolino:, better? TylerDurden8823 (talk) 00:03, 6 April 2020 (UTC)

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars, etc.:

6. It is illustrated by images and other media, where possible and appropriate.

   a (images are tagged and non-free content have fair use rationales): b (appropriate use with suitable captions):

7. Overall:

   Pass/Fail: