Update in lean metabolic dysfunction-associated steatotic liver disease  

作　　者：Karina Sato-Espinoza Perapa Chotiprasidhi Mariella R Huaman Javier Díaz-Ferrer 

机构地区：[1]Division of Gastroenterology and Hepatology,Department of Medicine,Mayo Clinic,Rochester,MN 55902,United States [2]Obesity and Metabolic,Center for Obesity and Metabolic Health,Lima 02002,Lima,Peru [3]Hepatology Service,Department of Digestive Diseases,Hospital Nacional Edgardo Rebagliati Martins,Lima 02002,Lima,Peru [4]Medicine Faculty,Universidad San Martin de Porres,Lima 02002,Lima,Peru [5]Gastroenterology Service,Clinica Internacional,Lima 02002,Lima,Peru

出　　处：《World Journal of Hepatology》2024年第3期452-464,共13页世界肝病学杂志（英文版）（电子版）

摘　　要：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

关 键 词：LEAN NON-OBESE Non-alcoholic fatty liver disease Metabolic dysfunction-associated fatty liver disease Metabolic dysfunction-associated steatotic liver disease Guidelines Diagnosis Management PATHOGENESIS Treatment 

分 类 号：R575.5[医药卫生—消化系统]