瘦代谢功能障碍相关脂肪肝的最新进展。

IF 2.5 Q2 GASTROENTEROLOGY & HEPATOLOGY
Karina Sato-Espinoza, Perapa Chotiprasidhi, Mariella R Huaman, Javier Díaz-Ferrer
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引用次数: 0

摘要

背景:对于以前被称为非酒精性脂肪肝(NAFLD)和代谢功能障碍相关性脂肪肝(MAFLD)的肝脏疾病,已经形成了一种新的命名共识。现在,它们被定义为代谢功能障碍相关性脂肪肝(MASLD),其中包括成人的心脏代谢标准。这种疾病在肥胖或超重患者中得到广泛研究,约占总人口的 30%,在全球范围内呈稳步增长趋势。瘦削患者约占 MASLD 患者的 10%-15%。目的:系统回顾有关瘦型 MASLD 患者的诊断、发病机制、特征和预后的文献,并对这些新标准进行解读:2012年1月至2023年9月期间,我们在PubMed和Google Scholar上进行了全面的数据库检索,特别关注了瘦型非酒精性脂肪肝、MAFLD或MASLD患者。我们纳入了患者年龄在 18 岁或 18 岁以上、瘦体重指数根据世界卫生组织标准分类的原创文章,一般人群的瘦体重指数以 25 kg/m2 为临界值,亚洲人群的瘦体重指数以 23 kg/m2 为临界值:我们在分析中纳入了 85 项研究。我们的研究结果显示,非酒精性脂肪肝患者的患病率差异很大,从 3.8% 到 34.1%不等。确切的发病机制仍难以确定,与遗传变异、表观遗传修饰和适应性代谢反应有关。常见的风险因素包括代谢综合征、高血压和 2 型糖尿病,但其患病率因瘦弱患者的对比组而异。在非侵入性工具方面,瘦病人的纤维化-4指数优于非酒精性脂肪肝纤维化评分。生活方式的调整有助于减轻肝脏脂肪变性和改善心脏代谢状况,一些药物的疗效较弱。然而,与肥胖或超重患者相比,非酒精性脂肪肝患者的预后较差:结论:非酒精性脂肪肝是一种复杂的疾病,其发病机制包括表观遗传、基因和代谢因素。不同人群、性别和年龄的结果各不相同。有关瘦弱患者临床实践指南的数据有限。未来采用这种新命名法的研究将有助于标准化和推广瘦人脂肪肝患者的研究结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Update in lean metabolic dysfunction-associated steatotic liver disease.

Background: A new nomenclature consensus has emerged for liver diseases that were previously known as non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD). They are now defined as metabolic dysfunction-associated steatotic liver disease (MASLD), which includes cardiometabolic criteria in adults. This condition, extensively studied in obese or overweight patients, constitutes around 30% of the population, with a steady increase worldwide. Lean patients account for approximately 10%-15% of the MASLD population. However, the pathogenesis is complex and is not well understood.

Aim: To systematically review the literature on the diagnosis, pathogenesis, characteristics, and prognosis in lean MASLD patients and provide an interpretation of these new criteria.

Methods: We conducted a comprehensive database search on PubMed and Google Scholar between January 2012 and September 2023, specifically focusing on lean NAFLD, MAFLD, or MASLD patients. We include original articles with patients aged 18 years or older, with a lean body mass index categorized according to the World Health Organization criteria, using a cutoff of 25 kg/m2 for the general population and 23 kg/m2 for the Asian population.

Results: We include 85 studies in our analysis. Our findings revealed that, for lean NAFLD patients, the prevalence rate varied widely, ranging from 3.8% to 34.1%. The precise pathogenesis mechanism remained elusive, with associations found in genetic variants, epigenetic modifications, and adaptative metabolic response. Common risk factors included metabolic syndrome, hypertension, and type 2 diabetes mellitus, but their prevalence varied based on the comparison group involving lean patients. Regarding non-invasive tools, Fibrosis-4 index outperformed the NAFLD fibrosis score in lean patients. Lifestyle modifications aided in reducing hepatic steatosis and improving cardiometabolic profiles, with some medications showing efficacy to a lesser extent. However, lean NAFLD patients exhibited a worse prognosis compared to the obese or overweight counterpart.

Conclusion: MASLD is a complex disease comprising epigenetic, genetic, and metabolic factors in its pathogenesis. Results vary across populations, gender, and age. Limited data exists on clinical practice guidelines for lean patients. Future studies employing this new nomenclature can contribute to standardizing and generalizing results among lean patients with steatotic liver disease.

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来源期刊
World Journal of Hepatology
World Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.10
自引率
4.20%
发文量
172
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