From the Research
Patients with Metabolic dysfunction-associated fatty liver disease (MFALD) who progress to cirrhosis should be managed with a comprehensive approach that includes lifestyle modifications, first-line pharmacotherapy, and standard cirrhosis care, with a focus on reducing morbidity, mortality, and improving quality of life. The primary approach includes lifestyle modifications with weight loss of 7-10% through a Mediterranean or DASH diet combined with regular exercise (150 minutes weekly of moderate activity) 1. First-line pharmacotherapy includes pioglitazone (15-30mg daily) for patients with type 2 diabetes and vitamin E (800 IU daily) for non-diabetic patients with biopsy-proven NASH.
For cirrhosis management, add standard cirrhosis care including:
- Screening for varices with endoscopy every 1-2 years
- Hepatocellular carcinoma screening with ultrasound and AFP every 6 months
- Management of complications like ascites with sodium restriction and diuretics (spironolactone starting at 100mg daily with furosemide 40mg daily if needed)
- Abstinence from alcohol is essential as it accelerates disease progression
- Regular monitoring of liver function tests every 3-6 months is recommended In addition to these measures, the use of non-selective beta-blockers (NSBBs), such as carvedilol, is recommended for the management of portal hypertension in patients with cirrhosis, as it has been shown to reduce the risk of variceal bleeding and improve survival 2, 3. The target dose of carvedilol to treat portal hypertension should be 12.5 mg/day 2.
It is essential to note that the management of MFALD-related cirrhosis should be individualized, and the treatment approach should be tailored to the specific needs of each patient, taking into account the presence of comorbidities, the severity of liver disease, and the risk of complications. The goal of treatment is to reduce morbidity, mortality, and improve quality of life, and a comprehensive approach that includes lifestyle modifications, pharmacotherapy, and standard cirrhosis care is essential to achieve this goal.