With an emphasis on prevention and early screening, the MASLD guidelines provide a clear, innovative path to managing liver health.
In a monumental leap forward, the Latin American Association for the Study of the Liver Working Group has unveiled fresh guidelines to combat the ever-growing threat of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called NAFLD (non-alcoholic fatty liver disease), one of the top causes of chronic liver disorders worldwide.
With an eye on the 2023 definition, MASLD is defined by metabolic dysfunction and limited alcohol consumption—less than 140 grams for women and 210 grams per week for men—making it a complex and widespread health issue.
Here’s how the new recommendations are reshaping care:
1. Simplifying Diagnosis
The road to detection just became clearer. Ultrasonography is the preferred initial screening tool for hepatic steatosis, offering a fast, accessible, and reliable way to begin the fight. For a more detailed look at liver damage, fibrosis-4 (FIB-4) is the go-to method for fibrosis risk stratification, guiding healthcare professionals towards more explicit techniques like vibration-controlled transient elastography and the enhanced liver fibrosis (ELF) test.
2. Lifestyle First: A Focus on Diet and Weight
Diet and weight loss are taking centre stage as pivotal treatment strategies. The Mediterranean diet (comprising of healthy fats, fibre, and antioxidants) is advised for all MASLD patients. For those struggling with excess weight, the goal is clear: a 7-10% weight loss to help combat the disease’s progression.
3. A Bold Stance on Alcohol and Smoking
Total abstinence from alcohol is vital for patients with marked fibrosis. Meanwhile, smoking cessation is strongly advised for everyone, regardless of their fibrosis stage, recognizing the power of a healthy lifestyle can help fight the disease.
4. Personalized Drug Options
Depending on the patient's specific needs—whether it’s dealing with steatohepatitis, liver fibrosis, excess weight, or diabetes—a range of cutting-edge therapies are available, including resmetirom, incretin-based therapies, pioglitazone, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Bariatric surgery (weight-loss surgery) can also be considered for those with obesity who don’t respond to lifestyle modifications or medicines.
5. Stay Ahead of Cancer: Screening for Hepatocellular Carcinoma
The guidelines also prioritize early detection of hepatocellular carcinoma. Routine screenings for cirrhotic patients are a must, and for those with advanced fibrosis, screenings are suggested on a case-by-case basis, founded on their risk factors.
6. A Holistic Move Forward: Focus on Cardiovascular Health and Diabetes
Understanding the interconnectedness of liver and heart health, the guidelines emphasize cardiovascular risk assessments and diabetes prevention and management for every patient with MASLD, addressing overall health challenges associated with the disease.
Annals of Hepatology
Updated recommendations for the management of metabolic dysfunction–associated steatotic liver disease (MASLD) by the Latin American working group.
Luis Antonio Diaz et al.
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