Ahmadizar Fariba, Younossi Zobair M
Data Science and Biostatistics Department, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
J Clin Gastroenterol. 2025 Jan 1;59(1):36-46. doi: 10.1097/MCG.0000000000002079.
Integrating biomarkers into a comprehensive strategy is crucial for precise patient management, especially considering the significant healthcare costs associated with diseases. Current studies emphasize the urgent need for a paradigm shift in conceptualizing nonalcoholic fatty liver disease (NAFLD), now renamed metabolic dysfunction-associated steatotic liver disease (MASLD). Biomarkers are emerging as indispensable tools for accurate diagnosis, risk stratification, and monitoring disease progression. This review classifies biomarkers into conventional and novel categories, such as lipids, insulin resistance, hepatic function, and cutting-edge imaging/omics, and evaluates their potential to transform the approach to MASLD among individuals with type 2 diabetes mellitus (T2D). It focuses on the critical role of biomarkers in early MASLD detection, enhancing predictive accuracy, and discerning responses to interventions (pharmacological or lifestyle modifications). Amid this discussion, the complexities of the relationship between T2D and MASLD are explored, considering factors like age, gender, genetics, ethnicity, and socioeconomic background. Biomarkers enhance the effectiveness of interventions and support global initiatives to reduce the burden of MASLD, thereby improving public health outcomes. This review recognizes the promising potential of biomarkers for diagnostic precision while candidly addressing the challenges in implementing these advancements in clinical practice. The transformative role of biomarkers emerges as a central theme, promising to reshape our understanding of disease trajectories, prognosis, and the customization of personalized therapeutic strategies for improved patient outcomes. From a future perspective, identifying early-stage biomarkers, understanding environmental impact through exposomes, and applying a multiomics approach may reveal additional insight into MASLD development.
将生物标志物整合到综合策略中对于精准的患者管理至关重要,尤其是考虑到与疾病相关的巨大医疗成本。当前的研究强调迫切需要在概念化非酒精性脂肪性肝病(NAFLD,现更名为代谢功能障碍相关脂肪性肝病(MASLD))方面进行范式转变。生物标志物正成为准确诊断、风险分层和监测疾病进展不可或缺的工具。本综述将生物标志物分为传统和新型类别,如脂质、胰岛素抵抗、肝功能以及前沿成像/组学,并评估它们在改变2型糖尿病(T2D)患者中MASLD治疗方法方面的潜力。它侧重于生物标志物在早期MASLD检测、提高预测准确性以及辨别对干预措施(药物或生活方式改变)的反应方面的关键作用。在这一讨论中,探讨了T2D与MASLD之间关系的复杂性,考虑了年龄、性别、遗传、种族和社会经济背景等因素。生物标志物提高了干预措施的有效性,并支持全球减少MASLD负担的倡议,从而改善公共卫生结果。本综述认识到生物标志物在诊断精准性方面的巨大潜力,同时坦率地面对在临床实践中实施这些进展所面临的挑战。生物标志物的变革性作用成为一个核心主题,有望重塑我们对疾病轨迹、预后的理解,以及为改善患者结局而定制个性化治疗策略。从未来的角度来看,识别早期生物标志物、通过暴露组了解环境影响以及应用多组学方法可能会揭示对MASLD发展的更多见解。