Torp Nikolaj, Israelsen Mads, Krag Aleksander
Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Nat Rev Gastroenterol Hepatol. 2025 Apr;22(4):281-292. doi: 10.1038/s41575-024-01022-y. Epub 2024 Dec 5.
The classification of steatotic liver disease (SLD) has evolved, incorporating all conditions characterized by hepatic lipid accumulation. SLD represents a continuum of disorders that are shaped by the dynamic factors of alcohol intake and cardiometabolic risk factors. This updated classification has profound implications for both the management and research of SLD, especially with the new distinct category of patients with both metabolic and alcohol-related liver disease. In this Perspective, we highlight the pivotal role of alcohol within the SLD framework. We introduce the 'SLD burden paradox': a concept illustrating the disparity in which metabolic dysfunction-associated steatotic liver disease is more prevalent, yet individuals with SLD and excessive alcohol intake (such as in metabolic and alcohol-related liver disease and in alcohol-related liver disease) account for greater global liver-related morbidity and mortality. We explore strategies to mitigate the effect of SLD on morbidity and mortality, emphasizing the importance of early detection and reducing stigma associated with alcohol intake. Our discussion extends to methods for assessing and monitoring alcohol intake together with the critical role of managing cardiometabolic risk factors in patients across the SLD spectrum. Conclusively, we advocate for a coordinated care framework that adopts a person-centric approach when managing SLD, aiming to improve outcomes and patient care.
脂肪性肝病（SLD）的分类已经演变，纳入了所有以肝脏脂质蓄积为特征的病症。SLD代表了一系列由酒精摄入和心脏代谢危险因素等动态因素所塑造的疾病。这种更新后的分类对SLD的管理和研究具有深远影响，尤其是对于代谢性和酒精相关性肝病兼具的新的独特患者类别。在这篇观点文章中，我们强调了酒精在SLD框架中的关键作用。我们引入了“SLD负担悖论”：这一概念阐释了一种差异，即代谢功能障碍相关脂肪性肝病更为普遍，但SLD患者以及过量饮酒者（如在代谢性和酒精相关性肝病以及酒精性肝病中）却占全球肝脏相关发病率和死亡率的更大比例。我们探讨了减轻SLD对发病率和死亡率影响的策略，强调了早期检测以及减少与酒精摄入相关的污名化的重要性。我们的讨论还延伸至评估和监测酒精摄入的方法，以及在整个SLD谱系患者中管理心脏代谢危险因素的关键作用。最后，我们倡导一种协调护理框架，该框架在管理SLD时采用以患者为中心的方法，旨在改善治疗结果和患者护理。
