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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.
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.