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World J Hepatol. Jan 27, 2024; 16(1): 33-40
Published online Jan 27, 2024. doi: 10.4254/wjh.v16.i1.33
Metabolic disease and the liver: A review
Márcia Vargas, Sheila de Castro Cardoso Toniasso, Patricia G Riedel, Camila Pereira Baldin, Francielle Lopes dos Reis, Robson Martins Pereira, Maria Carlota Borba Brum, Dvora Joveleviths, Mario Reis Alvares-da-Silva
Márcia Vargas, Dvora Joveleviths, Program of Graduate Science in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre 90040-060, Rio Grande do Sul, Brazil
Sheila de Castro Cardoso Toniasso, Patricia G Riedel, Francielle Lopes dos Reis, Maria Carlota Borba Brum, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90040-060, Brazil
Camila Pereira Baldin, Program of Graduate Science in Gastroenterology and Hepatology, Clinicas Hospital of Porto Alegre, Porto Alegre 90410000, Brazil
Robson Martins Pereira, Medicine Faculty Federal University of Rio Grande do Sul, Federal University of Rio Grande do Sul, Porto Alegre 90040-060, Brazil
Mario Reis Alvares-da-Silva, Division of Gastroenterology and Hepatology, Clinicas Hospital of Porto Alegre, Porto Alegre 90035007, Brazil
Author contributions: Vargas V, Joveleviths D, and Brum MCB contributed to design conceptualization, methodology, and investigation; Toniasso PGR, Reis FL, Pereira RL, and Baldin CP performed data curation and writing the original draft; Joveleviths D and Vargas M contributed to formal analysis, project administration, validation, and reviewing and editing; Joveleviths D and Vargas V wrote the final version; All authors read and approved the final draft for publication.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dvora Joveleviths, Doctor, PhD, Professor, Researcher, Program of Graduate Science in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, 90040-060, Porto Alegre 90035-002, Rio Grande do Sul, Brazil. dvorajov@gmail.com
Received: October 10, 2023
Peer-review started: October 10, 2023
First decision: October 16, 2023
Revised: November 6, 2023
Accepted: January 5, 2024
Article in press: January 5, 2024
Published online: January 27, 2024
Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, with an estimated prevalence of 31% in Latin America. The presence of metabolic comorbidities coexisting with liver disease varies substantially among populations. It is acknowledged that obesity is boosting the type 2 diabetes mellitus “epidemic,” and both conditions are significant contributors to the increasing number of patients with MASLD. Non-alcoholic steatohepatitis represents a condition of chronic liver inflammation and is considered the most severe form of MASLD. MASLD diagnosis is based on the presence of steatosis, noninvasive scores and altered liver tests. Noninvasive scores of liver fibrosis, such as serum biomarkers, which should be used in primary care to rule out advanced fibrosis, are simple, inexpensive, and widely available. Currently, guidelines from international hepatology societies recommend using noninvasive strategies to simplify case finding and management of high-risk patients with MASLD in clinical practice. Unfortunately, there is no definite pharmacological treatment for the condition. Creating public health policies to treat patients with risk factors for MASLD prevention is essential.

Keywords: Nonalcoholic fatty liver disease, Primary care, Metabolic risk, Liver, Metabolism

Core Tip: Metabolic dysfunction-associated steatotic liver disease must be prevented in primary care by focusing on risk factors for metabolic syndrome and noninvasive fibrosis scores so that early detection is possible. To avoid a late diagnosis, primary care physicians need to reinforce in their routine examinations the need for lifestyle changes through healthy diet and exercise and implement pharmacological treatment when disease progression with the presence of fibrosis is identified. The treatment must be individualized, and in many cases several pharmacological options may be used to avoid disease progression, resulting in multisystemic involvement.