New CMJ Review explores the metabolic dysfunction associated fatty liver disease

Metabolic (dysfunction) associated fatty liver disease (MAFLD) is a common condition worldwide. A trend of increasing cases of MAFLD was noted during 2009–2019 in the Asia Pacific, with a substantial increase projected in MAFLD cases and related deaths by 2030. These trends will put an enormous financial and social burden on society.

Now, in a review made available online on February 21 2022 and published on March 5, 2022, in volume 135, issue 5 of Chinese Medical Journal, researchers from the University of Sydney summarize the current information on MAFLD. This disease is quite varied in its presentation because of the myriad of factors responsible for the disease, which is characterized by accumulation of fat in the liver cells, subsequently resulting in oxidative stress. According to Dr. Jacob George, a corresponding author of the review, “This triggers a cascade of mechanisms leading to cellular damage and release of proinflammatory molecules, causing inflammation of the liver cells. This is called steatohepatitis.”

Inflammation is crucial in progression of MAFLD, because it induces fibrosis in the liver, eventually leading to cirrhosis with a high risk of progression to hepatocellular carcinoma.  However, the exact mechanism of this progression is not completely clear.

MALFD is challenging to diagnose clinically, as most patients are asymptomatic and there are no definitive blood tests.  The diagnosis is made when the fat accumulation is reported (either on imaging or histologic observation) with some pre-existing conditions. These diseases, which predispose the individual to developing MAFLD, include obesity, type 2 diabetes, and hypertension, among others. The management of MAFLD focuses on treating the underlying pre-existing condition. Additionally, vitamin E supplementation is recommended to patients with advanced fibrosis.

Moving forward, Dr. Liang Qiao, also the corresponding author, predicts, “Burden of MAFLD is going to increase in the future, more research is required to understand the disease and its progression at a molecular level.” Current research is aiming to identify novel biomarkers specific to MALFD which might assist in its early diagnosis. High-efficacy drugs for MALFD are in various stages of development. One of them, obeticholic acid, has shown to reduce inflammation in steatohepatitis patients in phase 2 clinical trials. Hopefully, as we understand more about this disease, better treatments will emerge.

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Reference

DOI: https://doi.org/10.1097/CM9.0000000000002089