Metabolic hepatic steatosis, do we know how to diagnose it?
Keywords:
metabolic hepatic steatosis, diabetesAbstract
Metabolic hepatic steatosis (MHE), known in English by the acronym MASLD (metabolic associated steatotic liver disease), has become the most common chronic liver disease, and its prevalence will continue to increase. The presence of EHM is strongly related to type 2 diabetes mellitus (T2DM), obesity and other cardiometabolic risk factors.
For this reason, different scientific societies have recently updated Clinical Practice Guidelines such as the EASL-EASD-EASO 2024 and the ADA Position Statement 2024 to guide clinicians in the tracking of patients at high risk of EHM and their stratification for treatment. risk of developing liver fibrosis and intensification of treatment.
In point 4.2 a of the 2024 ADA Recommendation Guide, it is proposed that in patients with DM2 or prediabetes, HME screening and stratification of clinically significant liver fibrosis be performed through the FIB4 risk score, although the enzymes liver cells are normal. Those with an undetermined or high risk should be evaluated with elastography and referred to a Hepatology specialist. These patients should be treated by multidisciplinary teams in the long term.
References
I. EASL-EASD-EASO Clinical Practice Guidelines on the mangement of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepathology 2024 (article in press).
II. Villamil FG, et al. Prevalence of non-alcoholic fatty liver disease and liver fibrosis in a general population cohort from Argentina. Ann Hepatol 2023;28:101111.
III. Lomonaco R, et al. Advanced liver fibrosis is common in patients with type 2 diabetes followed in the outpatient setting. The need for systematic screening. Diabetes Care 2021 Feb;44(2):339-406. doi:10.2337/dc20-1997.
IV. Comprehensive medical evaluation and assesment of comorbidities. Standards of Care in Diabetes 2024.Diabetes Care 2024;47(Supplement_1):S52-S76.
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