Applicability of the New Criteria for Diagnosis of Metabolic Dysfunction-Associated Fatty Liver Disease (MALFD) in Patients with Non-Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease affects 1/3 to ¼ of the world’s population. Currently this pathology is being redefined by using the acronym MALFD (Metabolic Dysfunction-Associated Fatty Liver Disease) and the possibility of new criteria for its diagnosis is being discussed. Methodology: Prospective and descriptive studies carried out between July 2018 and June 2020 where the applicability of the new criteria in MAFLD diagnosis were valued. Patients with NAFLD (Non-alcoholic fatty liver disease) were enrolled in clinics specialized in this pathology. Results: Out of 172 patients enrolled, 96.4% (this represents a total of 165 patients) presented obesity, were over weighted and or presented Diabetes Mellitus. The rest of the patients (a total of 7) presented high blood pressure and or dyslipidemia. Moreover, it was observed that the higher the obesity index the higher the prevalence of Diabetes Mellitus. Conclusions: The criteria for the diagnosis of MAFLD are adaptable in patients with a diagnosis of NAFLD from the first consultation and allow the assessment of prognostic elements of the disease. This would allow us to intervene at very early stages which could impact patient’s prognosis

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Non-alcoholic fatty liver disease: time for changes

INTERNATIONAL JOURNAL OF ENDOCRINOLOGY ◽

10.22141/2224-0721.17.4.2021.237350 ◽

2021 ◽

Vol 17 (4) ◽

pp. 334-345

Author(s):

T.I. Yefimenko ◽

M.R. Mykytyuk

Keyword(s):

Diabetes Mellitus ◽

Hepatocellular Carcinoma ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Metabolic Dysfunction ◽

Alcoholic Fatty Liver ◽

Close Relationship ◽

Alcoholic Fatty Liver Disease

The review contains updated information on the epidemiology, etiology, pathogenesis, diagnosis, treatment and prevention of non-alcoholic fatty liver disease (NAFLD). We searched for terms including NAFLD, non-alcoholic steatohepatitis (NASH), metabolic syndrome and type 2 diabetes mellitus in literature published over the past 5 years using the Scopus, Web of Science, CyberLeninka, PubMed databases. The concept of NAFLD includes two morphological forms of the disease with different prognosis: non-alcoholic fatty hepatosis and NASH. The severity of NASH is quite variable, including fibrosis, cirrhosis and hepatocellular carcinoma. NAFLD, a spectrum of fatty liver disorders of viral, autoimmune, drug-induced, and genetic origin, which are not caused by alcohol abuse, has recently been renamed as metabolic (dysfunction) associated fatty liver disease (MAFLD). The average prevalence of NAFLD is approximately 25 % among the adult population worldwide, and in some regions exceeds 30 %. An increase in the prevalence of this pathology is in parallel with the global epidemic of obesity and type 2 diabetes mellitus in the world. It is time to reach a general consensus in the scientific community on changing the nomenclature and moving from a negative to a positive definition of NAFLD/NASH. The new nomenclature points to the “positive” determinants of the disease, namely the close relationship with metabolic disorders, instead of defining it as what it is not (ie. non-alcoholic). The MAFLD abbreviation more accurately discloses existing knowledge about fatty liver diseases associated with metabolic dysfunction and should replace NAFLD/NASH, as this will stimulate the research community’s efforts to update the disease nomenclature and subphenotype and accelerate the transition to new treatments. It is important that primary care physicians, endocrinologists, and other specialists are aware of the extent and long-term consequences of NAFLD. Early identification of patients with NASH can help improve treatment outcomes, avoid liver transplantation in patients with decompensated cirrhosis. There are currently no effective treatments for NAFLD, so it is important to follow a multidisciplinary approach, which means using measures to improve prognosis, reduce the risk of death associated with NAFLD, the development of cirrhosis or hepatocellular carcinoma. Epidemiological data suggest a close relationship between unhealthy lifestyles and NAFLD, so lifestyle adjustments are needed to all patients. Insulin sensitizers, statins, ezetimibe, a cholesterol absorption inhibitor, hepatoprotectors, antioxidants, incretin analogues, dipeptidyl peptidase 4 inhibitors, pentoxifylline, probiotics, angiotensin-converting enzyme inhibitors, and endocannabinoid antagonists are used in the treatment of NAFLD.

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Evaluation the Predictors of Non-Alcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes Mellitus (T2DM) Patients

Systematic Reviews in Pharmacy ◽

10.31838/srp.2020.5.58 ◽

2020 ◽

Vol 11 (05) ◽

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

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Have we learnt all from Improve-It? Part I. Core results and subanalyses on the effects of ezetimibe added to statin therapy related to age, gender and selected chronic diseases (kidney disease, diabetes mellitus and non- alcoholic fatty liver disease)

Current Vascular Pharmacology ◽

10.2174/1570161118999200727224946 ◽

2020 ◽

Vol 18 ◽

Author(s):

Zlatko Fras ◽

Dimitri P. Mikhailidis

Keyword(s):

Diabetes Mellitus ◽

Liver Disease ◽

High Risk ◽

Kidney Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

Risk Patients ◽

Very High ◽

Alcoholic Fatty Liver Disease

: IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial) was a randomized clini- cal trial (18,144 patients) that evaluated the efficacy of the combination of ezetimibe with simvastatin vs simvastatin mono- therapy in patients with acute coronary syndrome (ACS) and moderately increased low-density lipoprotein cholesterol (LDL-C) levels (of up to 2.6-3.2 mmol/L; 100-120 mg/dL). After 7 years of follow-up, combination therapy resulted in an additional LDL-C decrease [1.8 mmol/L, or 70 mg/dL, within the simvastatin (40 mg/day) monotherapy arm and 1.4 mmol/L, or 53 mg/dL for simvastatin (40 mg/day) + ezetimibe (10 mg/day)] and showed an incremental clinical benefit (composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary re- vascularization (≥30 days after randomization), or nonfatal stroke; hazard ratio (HR) of 0.936, and 95% CI 0.887-0.996, p=0.016). Therefore, for very high cardiovascular risk patients “even lower is even better” regarding LDL-C, independently of the LDL-C reducing strategy. These findings confirm ezetimibe as an option to treat very-high-risk patients who cannot achieve LDL-C targets with statin monotherapy. Additional analyses of the IMPROVE-IT (both prespecified and post-hoc) include specific very-high-risk subgroups of patients (those with previous acute events and/or coronary revascularization, older than 75 years, as well as patients with diabetes mellitus, chronic kidney disease or non-alcoholic fatty liver disease). The data from IMPROVE-IT also provide reassurance regarding longer-term safety and efficacy of the intensification of li- pid-lowering therapy in very-high-risk patients resulting in very low LDL-C levels. We comment on the results of several (sub) analyses of IMPROVE-IT.

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