METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE: UPDATE

Doença hepática esteatótica associada à disfunção metabólica: revisão de literatura

ABSTRACT

Background:   Since Ludwig proposed the term “nonalcoholic steatohepatitis” (NASH) for this liver disease in 1980, there have been many advances in understanding it, including its epidemiology, pathogenesis, diagnostic methods, and treatment.

Objective:   This literature review aims to discuss the most relevant aspects of metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods:   The review included clinical studies from the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus.

Results:   MASLD is the most frequent liver disease worldwide, with increasing prevalence and incidence, and can evolve with liver cirrhosis and hepatocellular carcinoma. The diagnosis involves specific diagnostic criteria involving the presence of hepatic steatosis and other metabolic factors. Drug treatment, still in its incipient, involves pioglitazone, glucagon-like peptide-1 (GLP1) agonists, and sodium glucose cotransporter-2 (SGLT2) inhibitors, especially in diabetic patients. More recently, the Food and Drug Administration (FDA) approved Resmetiron for selected cases.

Conclusion:   MASLD is extremely common, presents complex pathophysiology, and requires an intensive multidisciplinary approach. It is hoped that future studies will provide effective and accessible pharmacological therapeutic options for the disease. It is necessary to bring the population’s attention to this condition, which can be associated with significant morbidity and mortality.

Keywords:
Steatotic liver disease; metabolic dysfunction-associated stea­totic liver disease; MASLD; liver fibrosis; metabolic syndrome; genetic polymorphisms; and drug therapy

HIGHLIGHTS

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease globally and a major risk factor for cirrhosis and hepatocellular carcinoma, even without cirrhosis. It refers to steatotic liver disease linked to metabolic syndrome.

• Fibrosis assessment is crucial as it impacts disease prognosis and can be done via non-invasive scores, elastography, or liver biopsy in select cases. MASLD is associated with hepatocellular carcinoma in up to 40% of cases, with 35.5% occurring in advanced fibrosis or cirrhosis.

• Treatment includes GLP-1 agonists and SGLT2 inhibitors, primarily for T2DM and obesity. The FDA recently approved Resmeriton for MASLD with fibrosis stages 2 and 3. Bariatric surgery is an option for patients with BMI ≥35 kg/m² but requires caution in those with advanced fibrosis and portal hypertension due to decompensation risks.