Jain Parag, Jain Akanksha, Deshmukh Rohitas, Samal Pradeep, Satapathy Trilochan
Department of Pharmacology, Rungta College of Pharmaceutical Sciences and Research, Bhilai, C.G., India, 490024.
Department of Biotechnology, Bharti University, Durg, C.G., India.
Clin Res Hepatol Gastroenterol. 2025 Jun;49(6):102584. doi: 10.1016/j.clinre.2025.102584. Epub 2025 Mar 27.
Metabolic dysfunction-associated steatotic liver disease (MASLD), which includes the inflammatory subtype metabolic dysfunction-associated steatohepatitis, is a prominent cause of chronic liver disease with systemic effects. Insulin resistance, obesity, and dyslipidaemia produce MASLD in over 30 % of adults. It is a global health issue. From MASLD to MASH, hepatic inflammation and fibrosis grow, leading to cirrhosis, hepatocellular cancer, and extrahepatic complications such CVD, CKD, and sarcopenia. Effects of MASLD to MASH are mediated through mechanisms that include inflammation, oxidative stress, dysbiosis, and predisposition through genetic makeup. Advances in diagnostic nomenclature in the past few years have moved the emphasis away from NAFLD to MASLD, focusing on the metabolic etiology and away from the stigma of an alcoholic-related condition. Epidemiological data show a large geographical variability and increasing prevalence in younger populations, particularly in regions with high carbohydrate-rich diets and central adiposity. Lifestyle modification is considered as the main management of MASLD currently. This may include dietary intervention, exercise, and weight loss management. Pharmaceutical management is primarily aimed at metabolic dysfunction with promising findings for GLP-1 receptor agonists, pioglitazone and SGLT-2 inhibitors, which can correct both hepatic and systemic outcome. However, it still depends on well-integrated multidisciplinary care models by considering complex relationships between MASLD and its effects on extrahepatic organs. Determining complications at an early stage; developing precision medicine strategies; exploring new therapeutic targets will represent crucial factors in improving their outcomes. This review discuss the systemic nature of MASLD and calls for multiple collaborations to reduce its far-reaching health impacts and our quest for understanding its pathological mechanisms. Thus, collective efforts that are required to address MASLD are under the public health, clinical care, and research angles toward effectively containing its rapidly increasing burden.
代谢功能障碍相关脂肪性肝病（MASLD），包括炎症亚型代谢功能障碍相关脂肪性肝炎，是一种具有全身影响的慢性肝病的主要病因。胰岛素抵抗、肥胖和血脂异常在超过30%的成年人中导致MASLD。这是一个全球健康问题。从MASLD发展到MASH，肝脏炎症和纤维化加剧，导致肝硬化、肝细胞癌以及诸如心血管疾病、慢性肾脏病和肌肉减少症等肝外并发症。MASLD到MASH的影响是通过包括炎症、氧化应激、菌群失调以及基因构成易感性等机制介导的。过去几年诊断命名的进展已将重点从非酒精性脂肪性肝病转移到MASLD，关注代谢病因，而不再有酒精相关疾病的污名。流行病学数据显示，在年轻人群中存在很大的地域差异且患病率不断上升，尤其是在富含碳水化合物饮食和中心性肥胖的地区。生活方式改变目前被认为是MASLD的主要管理方式。这可能包括饮食干预、运动和体重管理。药物治疗主要针对代谢功能障碍，胰高血糖素样肽-1受体激动剂、吡格列酮和钠-葡萄糖协同转运蛋白2抑制剂有一些有前景的研究结果，它们可以改善肝脏和全身状况。然而，这仍依赖于综合良好的多学科护理模式，因为要考虑MASLD及其对肝外器官影响之间的复杂关系。早期确定并发症；制定精准医学策略；探索新的治疗靶点将是改善其预后的关键因素。本综述讨论了MASLD的系统性本质，并呼吁开展多项合作以减少其深远的健康影响以及我们对理解其病理机制的探索。因此，应对MASLD所需的集体努力涉及公共卫生、临床护理和研究等方面，以有效控制其迅速增加的负担。
