Published in:
17-10-2023 | Obesity | IM - COMMENTARY
A balloon is better than diet: the role of lifestyle changes in the management of obesity and steatotic liver, and need for a winning strategy
Published in: Internal and Emergency Medicine | Issue 1/2024
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Excessive liver fat accumulation, i.e., liver steatosis, has become the most common chronic liver disease worldwide [1]. Studies point to a close relationships between etiology and pathogenesis of liver steatosis and wrong lifestyles [2], disturbed metabolic homeostasis, and ongoing chronic and systemic inflammatory pathways involving several organs. As a consequence, a shift of paradigm is occurring, and the original acronym used for the diagnosis of the most frequent condition of liver steatosis, i.e., non-alcoholic fatty liver disease (NAFLD) [3] has recently changed to metabolic dysfunction-associated fatty liver disease (MAFLD) [4, 5], and to metabolic dysfunction-associated steatotic liver disease (MASLD) [6]. In principle, MASLD avoids potential stigmatization of patients while emphasizing the pathogenic and prognostic value of the link between fat over-storage in the liver and increased cardiometabolic risk (i.e., at least one of five cardiometabolic risk factors associated with insulin resistance and cardiovascular diseases, Table 1 [6]. The management of NAFLD/MAFLD/MASLD requires a multidisciplinary management between hepatologists, cardiologists, diabetologists and nutritionists, with a growing role for internists. In addition, differences in disease progression and related metabolic abnormalities can exist according to terminological classification. MAFLD, for example, identifies more patients at high risk to develop fibrosis and cardiometabolic alterations [7, 8].
Table 1
Cardiometabolic criteria considered in the diagnosis of MASLD in adults
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Body Mass Index (BMI) ≥ 25 kg/m2 [23 Asia] or waist circumference > 94 cm (males), 80 cm (females) or ethnicity adjusted
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Fasting serum glucose ≥ 5.6 mmol/L [100 mg/dL] or 2-h post-load glucose levels ≥ 7.8 mmol/L [≥ 140 mg/dL] or HbA1c ≥ 5.7% [39 mmol/L] or type 2 diabetes or treatment for type 2 diabetes
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Blood pressure ≥ 130/85 mmHg or specific antihypertensive drug treatment
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Plasma triglycerides ≥ 1.70 mmol/L [150 mg/dL] or lipid lowering treatment
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Plasma HDL-cholesterol ≤ 1.0 mmol/L [40 mg/dL] (males) and ≤ 1.3 mmol/L [50 mg/dL] (females) or lipid lowering treatment
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