Via practica 2/2021

Diabesity and liver diseases

Nonalcoholic fatty liver disease (NAFLD) is a metabolic disease representing the hepatic manifestation of a systemic metabolic disorder. An alteration of fatty acid metabolism and utilisation: supply, production, oxidation, and storage resulting in hepatic steatosis (NAFLD). In case of hepatocellular necroinflammatory injury (NASH) is the risk for fibrotic liver injury leading to cirrhosis and its complications. A new name for this disease affecting nearly one billion people globally is overdue, as knowledge gained from the past decades has assuringly demonstrated that MAFLD (metabolic associated fatty liver disease) is a purely metabolic disorder. New definition clearly establishes this disease as a metabolic disorder as criteria now require evidence of hepatic steatosis accompanied by one of three features: that is, either overweight or obesity, T2DM, or lean or normal weight with evidence of metabolic dysregulation. MAFLD brings this disease back to reality and closer not only to its pathophysiology but to T2DM. Fatty liver associated with metabolic dysfunction is common disease, affects a quarter of the population, and has no approved drug therapy. Although pharmacotherapies are in development, response rates appear modest.

Keywords: NAFLD/NASH, MAFLD/MASH, insulin resistance, T2DM, obesity