Guideline for the prevention and treatment of metabolic dysfunction-associated fatty liver disease (version 2024)

Non-alcoholic fatty liver disease (NAFLD) is a chronic, progressive liver condition primarily caused by overnutrition and insulin resistance. It encompasses a spectrum of diseases ranging from simple fatty liver to non-alcoholic steatohepatitis (NASH) and can progress to fibrosis, cirrhosis, and hepatocellular carcinoma. The global prevalence of NAFLD is increasing, particularly in China, driven by rising rates of obesity and type 2 diabetes mellitus (T2DM). NAFLD is associated with metabolic syndrome and T2DM, which further heightens the risk of cardiovascular disease, chronic kidney disease, and extrahepatic malignancies.

To standardize the screening, diagnosis, and management of NAFLD, the Chinese Society of Hepatology and the Chinese Medical Association published guidelines in 2018 and updated them in 2024 under the title "Guideline for the Prevention and Treatment of Metabolic Dysfunction-Associated Fatty Liver Disease (2024 Version)." In 2020 and 2023, international experts proposed renaming NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD), respectively. In Chinese, both terms are translated as "代谢相关脂肪性肝病."

The updated guidelines utilize a PICO format and a modified GRADE system, providing graded recommendations, emphasizing personalized treatment, and highlighting continuous updates based on the latest research and clinical needs.

Managing MAFLD requires a multidisciplinary approach involving hepatologists, endocrinologists, cardiologists, nutritionists, primary care physicians, and general practitioners, reflecting this condition's complexity and systemic nature. Lifestyle interventions, particularly weight management through energy-deficit diets and exercise, are foundational for preventing and treating sarcopenic obesity while promoting cardiovascular, renal, metabolic, and hepatic health. Pharmacological treatments, including GLP-1 receptor agonists, metformin, SGLT-2 inhibitors, statins, ACE inhibitors/angiotensin receptor blockers, and aspirin, can help mitigate cardiometabolic risks and may benefit liver health. Liver-directed therapies are specifically reserved for patients with metabolic dysfunction-associated steatohepatitis (MASH) who have significant fibrosis. Incretin-based therapies have emerged as a crucial component of comprehensive MAFLD/MASH management due to their effectiveness in addressing obesity and T2DM.

Although progress has been made in clinical hepatology, critical gaps remain in managing MAFLD and its associated complications, emphasizing the pressing need for additional research to enhance and refine clinical approaches. Key areas for future research and public health action include: (1) incorporating MAFLD into national chronic disease management frameworks, recognizing its role as a major contributor to chronic liver disease and its increasing public health significance; (2) building long-term patient cohorts with detailed clinical and biological data to harness multi-omics technologies for non-invasive monitoring of disease progression, especially MASH and fibrosis, and to identify biomarkers that predict treatment efficacy and long-term outcomes; (3) implementing large-scale, real-world observational studies and multicenter randomized controlled trials to assess the effectiveness of digital and pharmacological treatments for MAFLD/MASH in diverse populations; (4) developing a comprehensive big data platform to support dynamic cohort studies, employing artificial intelligence and machine learning to improve diagnostic accuracy, resolve classification controversies, and create personalized management strategies for different patient subgroups; and (5) tackling the growing prevalence of MAFLD among younger individuals and those with chronic HBV infection by expanding research on prevention and treatment approaches for these at-risk groups. These initiatives are essential for deepening the understanding of MAFLD, enhancing patient care, and reducing its escalating global health impact.

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https://www.xiahepublishing.com/2310-8819/JCTH-2024-00311

The study was recently published in the Journal of Clinical and Translational Hepatology.

The Journal of Clinical and Translational Hepatology (JCTH) is owned by the Second Affiliated Hospital of Chongqing Medical University and published by XIA & HE Publishing Inc. JCTH publishes high quality, peer reviewed studies in the translational and clinical human health sciences of liver diseases. JCTH has established high standards for publication of original research, which are characterized by a study’s novelty, quality, and ethical conduct in the scientific process as well as in the communication of the research findings. Each issue includes articles by leading authorities on topics in hepatology that are germane to the most current challenges in the field. Special features include reports on the latest advances in drug development and technology that are relevant to liver diseases. Regular features of JCTH also include editorials, correspondences and invited commentaries on rapidly progressing areas in hepatology. All articles published by JCTH, both solicited and unsolicited, must pass our rigorous peer review process.

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