J Hepatol. 2024 Sep;81(3):492-542. doi: 10.1016/j.jhep.2024.04.031. Epub 2024 Jun 7.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), is defined as steatotic liver disease (SLD) in the presence of one or more cardiometabolic risk factor(s) and the absence of harmful alcohol intake. The spectrum of MASLD includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH, previously NASH), fibrosis, cirrhosis and MASH-related hepatocellular carcinoma (HCC). This joint EASL-EASD-EASO guideline provides an update on definitions, prevention, screening, diagnosis and treatment for MASLD. Case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes, and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes (T2D) or obesity with additional metabolic risk factor(s). A stepwise approach using blood-based scores (such as FIB-4) and, sequentially, imaging techniques (such as transient elastography) is suitable to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes. In adults with MASLD, lifestyle modification - including weight loss, dietary changes, physical exercise and discouraging alcohol consumption - as well as optimal management of comorbidities - including use of incretin-based therapies (e.g. semaglutide, tirzepatide) for T2D or obesity, if indicated - is advised. Bariatric surgery is also an option in individuals with MASLD and obesity. If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) should be considered for a MASH-targeted treatment with resmetirom, which demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile. No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage. Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis.
代谢相关脂肪性肝病（MASLD），以前称为非酒精性脂肪性肝病（NAFLD），是指在存在一种或多种心血管代谢危险因素且无有害饮酒史的情况下发生的脂肪性肝病（SLD）。MASLD 的谱包括脂肪变性、代谢相关脂肪性肝炎（MASH，以前称为 NASH）、纤维化、肝硬化和 MASH 相关肝细胞癌（HCC）。本 EASL-EASD-EASO 联合指南提供了 MASLD 的定义、预防、筛查、诊断和治疗的更新。对于伴有肝纤维化的 MASLD，应使用非侵入性检测对有心血管代谢危险因素、肝酶异常和/或肝脏脂肪变性的影像学征象的个体进行病例发现策略，特别是在存在 2 型糖尿病（T2D）或肥胖症伴有其他代谢危险因素的情况下。使用基于血液的评分（如 FIB-4）和随后的影像学技术（如瞬时弹性成像）的逐步方法适用于排除/诊断晚期纤维化，后者可预测与肝脏相关的结局。对于 MASLD 成人患者，建议进行生活方式改变，包括减肥、饮食改变、体育锻炼和劝阻饮酒，以及优化合并症的管理，包括在有指征时使用基于肠促胰岛素的治疗（如司美格鲁肽、替西帕肽）治疗 T2D 或肥胖症。减重手术也是 MASLD 合并肥胖症患者的一种选择。如果在当地获得批准且取决于标签，对于非肝硬化 MASH 和显著肝纤维化（≥2 期）的成人，应考虑使用雷美替胺进行 MASH 靶向治疗，该药物在组织学上对脂肪性肝炎和纤维化具有有效性，且具有可接受的安全性和耐受性特征。目前对于肝硬化阶段，尚无 MASH 靶向的药物治疗。MASH 相关肝硬化的管理包括代谢药物的调整、营养咨询、门静脉高压和 HCC 的监测以及代偿失调性肝硬化的肝移植。
