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    Home > Active Ingredient News > Digestive System Information > Fatty liver harms nearly 200 million Chinese, and the latest guidelines give these new recommendations!

    Fatty liver harms nearly 200 million Chinese, and the latest guidelines give these new recommendations!

    • Last Update: 2022-03-07
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read and refer to the latest interpretation of domestic and foreign guidelines! There are more than 1.
    3 billion liver disease patients in the world, of which more than 400 million are in China, and of these more than 400 million Chinese patients, nearly half (> 200 million) have non-alcoholic fatty liver disease (NAFLD) - now, this This liver disease has a more apt name - Metabolic-Associated Fatty Liver Disease (MAFLD)
    .

    Figure 1: Epidemiological status of liver disease in China MAFLD is one of the chronic liver diseases with the highest incidence in China, which brings a serious public health burden
    .

    On January 25, 2022, Saudi J Gastroenterol issued clinical practice guidelines for the diagnosis and management of MAFLD (hereinafter referred to as "Egyptian clinical practice guidelines")
    .

    The editor will compare the updated content of the consensus with the MAFLD clinical diagnosis and treatment guidelines of the Asia-Pacific Association for the Study of the Liver for reference by clinicians
    .

    Definition change, improve diagnosis 1.
    Definition: Egyptian clinical practice guidelines follow the new definition of MAFLD in the international expert consensus statement, which renamed non-alcoholic fatty liver disease (NAFLD) as MAFLD.
    The diagnosis of MAFLD should be based on hepatic steatosis (through liver tissue).
    (1) overweight or obese; (2) type 2 diabetes mellitus (T2DM); (3) metabolic dysfunction clinical evidence
    .

    Figure 2: Flow chart of the diagnostic criteria for MAFLD II.
    Screening MAFLD has an insidious onset, slow progress, and generally asymptomatic
    .

    A small number of patients may have mild discomfort in the right upper quadrant, dull pain in the liver area or upper abdominal distention, fatigue and other non-specific symptoms, and some patients have liver enlargement
    .

    Severe steatohepatitis may present with symptoms such as nausea, vomiting, jaundice, and anorexia
    .

    The symptoms of liver cirrhosis due to other causes are similar to those of cirrhosis caused by other causes
    .

    Therefore, special attention should be paid to MAFLD screening in clinical practice.
    The Egyptian clinical practice guidelines for MAFLD screening are updated as follows, as shown in Table 1
    .

    Table 1: Contents of the updated guideline.
    New treatment methods to prevent disease progression 1.
    Non-drug management of MAFLD and life>
    .

    In general, dietary management includes volume restriction, a Mediterranean->
    .

    This Egyptian clinical practice guideline adds more coffee to dietary management
    .

    At the same time, for non-obese MAFLD patients, the body mass index (BMI) can be reduced by 5% through life>
    .

    2.
    Drug treatment of MAFLD (new) (1) Statins can reduce the morbidity and mortality of cardiovascular disease, and can be used for patients receiving obeticholic acid if necessary
    .

    (B1)(2) Vitamin E improves histological markers of disease activity; safety concerns remain
    .

    (B2)(3) Pioglitazone improves histological markers of MAFLD; however, safety concerns remain
    .

    (B2)(4) Metformin has no effect on liver tissue, but improves insulin resistance and may reduce the risk of hepatocellular carcinoma (HCC)
    .

    (B2) 3.
    Bariatric surgery for MAFLD (new) For overweight/obese MAFLD patients, when life>
    .

    (1) MAFLD patients can undergo bariatric surgery only if the following two criteria are met: 1) BMI > 40 kg/m2 or BMI > 35 kg/m2 with obesity-related comorbidities
    .

    2) No evidence of decompensated cirrhosis or associated portal hypertension
    .

    (B1)(2) The practicality and feasibility of bariatric surgery for MAFLD patients with BMI ≤35 kg/m2 is currently unknown
    .

    (C2)(3) Bariatric (metabolic) surgery improved all MAFLD parameters, including hepatic fat loss, remission of steatohepatitis, and resolution of fibrosis
    .

    (B1) Regular monitoring to avoid worsening MAFLD patients should be regularly monitored to avoid disease progression to liver fibrosis, liver cirrhosis, hepatocellular carcinoma and other diseases
    .

    Therefore, the Egyptian clinical practice guidelines recommend: (1) Patients without fibrosis, concomitant or worsening of metabolic risk factors can be monitored every 2 or 3 years
    .

    (C2)(2) Patients with fibrosis or concomitant metabolic risk factors should be monitored annually using a combination of noninvasive scoring and/or liver stiffness measurements
    .

    (C2)(3) Patients with cirrhosis should receive surveillance every 6 months, including surveillance for hepatocellular carcinoma
    .

    (A2) In addition, the Asia-Pacific Association for the Study of the Liver’s clinical diagnosis and treatment guidelines also recommend: (1) Non-invasive monitoring of fibrosis by liver fibrosis score and liver elasticity value (C2) (2) Patients at high risk of liver fibrosis progression can Liver biopsy every 5 years unless cirrhosis has been established (C2)
    .

    Note: According to a hierarchy, the evidence is classified into one of three levels: high (A), moderate (B) or low (C)
    .

    The GRADE system offers two recommendation levels: strong (1) and weak (2)
    .

    References: [1] Fouad Y, Esmat G, Elwakil R, et al.
    The egyptian clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease.
    Saudi J Gastroenterol.
    2022 Jan 25.
    doi: 10.
    4103/sjg.
    sjg_357_21 .
    Epub ahead of print.
    PMID:35083973.
    [2]Song Yu,Shi Junping.
    Metabolic-related fatty liver disease-related liver cirrhosis and cryptogenic liver cirrhosis[J].
    Chinese Journal of Liver Diseases,2021,29(03):213- 215.
    [3] Shi Yiwen, Xiao Qianqian, Fan Jiangao.
    Introduction to the clinical guidelines for the diagnosis and treatment of metabolic-related fatty liver disease of the Asia-Pacific Association for the Study of the Liver [J].
    Chinese Journal of Liver Diseases, 2020, 28(11): 915-917.
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