School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; National Institute for Health and Care Research, Southampton Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton, UK.
Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy.
Diabetes Metab. 2024 Jan;50(1):101506. doi: 10.1016/j.diabet.2023.101506. Epub 2023 Dec 21.
With the rising tide of fatty liver disease related to metabolic dysfunction worldwide, the association of this common liver disease with chronic kidney disease (CKD) has become increasingly evident. In 2020, the more inclusive term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace the old term non-alcoholic fatty liver disease (NAFLD). In 2023, a modified Delphi process was led by three large pan-national liver associations. There was consensus to change the fatty liver disease nomenclature and definition to include the presence of at least one of five common cardiometabolic risk factors as diagnostic criteria. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease (MASLD). The change of nomenclature from NAFLD to MAFLD and then MASLD has resulted in a reappraisal of the epidemiological trends and associations with the risk of developing CKD. The observed association between MAFLD/MASLD and CKD and our understanding that CKD can be an epiphenomenon linked to underlying metabolic dysfunction support the notion that individuals with MASLD are at substantially higher risk of incident CKD than those without MASLD. This narrative review provides an overview of the literature on (a) the evolution of criteria for diagnosing this highly prevalent metabolic liver disease, (b) the epidemiological evidence linking MASLD to the risk of CKD, (c) the underlying mechanisms by which MASLD (and factors strongly linked with MASLD) may increase the risk of developing CKD, and (d) the potential drug treatments that may benefit both MASLD and CKD.
随着全球代谢功能障碍相关脂肪性肝病发病率的上升,这种常见肝脏疾病与慢性肾脏病(CKD)的关联变得越来越明显。2020 年,提出了更具包容性的术语代谢功能障碍相关性脂肪性肝病(MAFLD)来取代旧术语非酒精性脂肪性肝病(NAFLD)。2023 年,三个大型泛国家肝脏协会领导了一个改良 Delphi 流程。专家们达成共识,将脂肪性肝病的命名和定义改为包括至少存在五种常见心血管代谢风险因素中的一种作为诊断标准。取代 NAFLD 的名称是代谢功能障碍相关性脂肪性肝病(MASLD)。从 NAFLD 到 MAFLD 再到 MASLD 的命名变化导致了对流行病学趋势和与 CKD 风险的关联的重新评估。观察到 MAFLD/MASLD 与 CKD 之间的关联,以及我们对 CKD 可能是与潜在代谢功能障碍相关的表现现象的理解,支持了这样一种观点,即患有 MASLD 的个体发生 CKD 的风险明显高于没有 MASLD 的个体。本综述概述了以下方面的文献:(a)用于诊断这种高度流行的代谢性肝病的标准的演变;(b)将 MASLD 与 CKD 风险联系起来的流行病学证据;(c)MASLD(和与 MASLD 密切相关的因素)可能增加发生 CKD 的风险的潜在机制;以及(d)可能对 MASLD 和 CKD 都有益的潜在药物治疗方法。
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