From the Guidelines
Metabolic Associated Fatty Liver Disease (MAFLD) is a condition characterized by excessive fat accumulation in the liver in people who have metabolic risk factors such as obesity, type 2 diabetes, or dyslipidemia, even without significant alcohol consumption, and its treatment should focus on lifestyle modifications and management of comorbidities to prevent long-term complications. The definition of MAFLD, as per the latest guidelines 1, emphasizes the presence of excess triglyceride storage in the liver in the presence of at least one cardiometabolic risk factor.
Key Components of MAFLD Treatment
- Lifestyle Modifications: The primary treatment for MAFLD focuses on lifestyle modifications, particularly weight loss of 7-10% of body weight through a combination of caloric restriction and regular exercise (at least 150 minutes of moderate-intensity physical activity weekly) 1.
- Dietary Changes: Dietary changes should emphasize reducing processed foods, simple carbohydrates, and saturated fats while increasing consumption of fruits, vegetables, whole grains, and lean proteins 1.
- Management of Comorbidities: Management of comorbidities such as hypertension, dyslipidemia, and diabetes is essential as these conditions can worsen liver damage 1.
Pharmacological Therapy
- Resmetirom: If approved locally and dependent on the label, adults with non-cirrhotic MASH with significant liver fibrosis (stage >2) should be considered for treatment with resmetirom as a MASH-targeted therapy 1.
- GLP-1 Receptor Agonists: GLP1RAs are safe to use in MASH (including compensated cirrhosis) and should be used for their respective indications, namely type 2 diabetes and obesity, as their use improves cardiometabolic outcomes 1.
Monitoring and Follow-Up
- Regular Monitoring: Regular monitoring with liver function tests and periodic imaging is recommended to track disease progression 1.
- Early Intervention: MAFLD can progress to cirrhosis and liver failure if left untreated, making early intervention crucial for preventing long-term complications 1.
From the Research
Definition of MAFLD
- Metabolic Associated Fatty Liver Disease (MAFLD) is a relatively novel classification that emphasizes the metabolic risk factors underlying the progression of non-alcoholic fatty liver disease (NAFLD)-associated pathology 2.
- The definition of MAFLD has replaced the previous definition of NAFLD, as cardiometabolic criteria have been added for the prevention of cardiological risk in these patients 3.
- MAFLD includes a wide spectrum of liver injury, including simple steatosis and non-alcoholic steatohepatitis (NASH), which may lead to serious complications such as liver cirrhosis and liver cancer 4.
Diagnosis of MAFLD
- All people with type 2 diabetes (T2D) and hepatic fat content >5% by biomarkers, imaging, or biopsy are considered to have MAFLD 2.
- Contemporary methods for quantifying liver fat and fibrosis, including those based on magnetic resonance imaging, are used to assess MAFLD 2.
Treatment of MAFLD
- Lifestyle modification, which includes correct nutrition combined with regular physical activity, represents the therapeutic cornerstone of MAFLD 3.
- Nutraceuticals such as silymarin, berberine, curcumin, Nigella sativa, Ascophyllum nodosum, and Fucus vesiculosus, vitamin E, coenzyme Q10, and Omega-3 may have a significant benefit on metabolic alterations and contribute to the improvement of hepatic steatosis 3.
- Pharmacological therapies such as incretins, Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors, and other similar therapies may assist in the prevention and reduction of cardiometabolic risk 3.
- Various drug classes, including peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, vitamin E, farnesoid X receptor agonists, selective thyroid hormone receptor-β agonists, and selective cholesterol absorption inhibitors, have been summarized for the treatment of MAFLD 5.