Inflammation and Cardiometabolic Disease Edition: Hepatic Inflammation and Metabolic Dysfunction-Associated Steatohepatitis (MASH)
Nov 14, 2024
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Delve into the often-overlooked world of liver fat deposits and their serious implications. Explore the relationship between hepatic inflammation and cardiometabolic diseases, including the alarming rise of steatohepatitis. Learn about risk factors, diagnostic advancements like elastography, and the role of the FIB-4 score. Discover the importance of early screening and effective management strategies, especially lifestyle modifications, to combat this escalating health concern affecting both adults and children.
Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) includes various forms and necessitates screening for at-risk populations to prevent severe complications.
The management of Metabolic Dysfunction Associated Steatohepatitis (MASH) focuses on lifestyle modifications and may involve new FDA-approved medications for advanced cases.
Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) represents a condition where fat accumulates in the liver due to underlying metabolic dysfunction. This umbrella term includes subcategories like Metabolic Dysfunction Associated Steatohepatitis (MASH), which is a more aggressive form of the disease, and MET-ALD, which refers to fatty liver in those who consume low to moderate amounts of alcohol. The primary risk factors related to MASLD involve insulin resistance, obesity, diabetes, dyslipidemia, and hypertension, with studies showing a significant prevalence of liver fat among diabetic patients. It is important that healthcare providers screen at-risk populations, as timely intervention can prevent progression to more severe liver disease.
Pathophysiology and Progression of Liver Disease
The pathophysiology of MASLD is complex and largely driven by a process called lipotoxicity, which occurs due to excess lipids in the liver. Factors like a diet high in processed sugars and saturated fats lead to increased intrahepatic triglycerides, resulting in fatty liver. Over time, this condition can progress to inflammation and eventually fibrosis, as the liver attempts to manage the lipotoxic injury. Although many individuals may present with hepatic steatosis, only about 20% progress to the more serious MASH, illustrating the necessity for regular monitoring and evaluation for those diagnosed with fatty liver.
Diagnosis and Management Strategies for MASH
Diagnosing MASH requires a combination of imaging techniques to assess liver fat and potential scarring, with elastography providing more detailed insights into liver stiffness. Management strategies focus heavily on lifestyle modifications, including dietary changes and increased physical activity, as these can significantly reduce liver fat and improve overall health. Medications may be considered for those with moderate to advanced fibrosis, particularly a newly FDA-approved treatment for patients meeting specific criteria. Continuous monitoring of liver health, including regular liver enzyme checks and imaging, is crucial for managing patients at risk to ensure timely intervention when necessary.
Fat deposits in the liver are quite common and many individuals have no idea they have the condition. A minority of those individuals will develop an associated hepatic inflammation. It’s not entirely clear why some progress to this state, although there are some known risk factors. Steatohepatitis is a potentially serious health problem and can lead to end-stage liver disease. It’s also associated with cardiovascular disease and all of its complications. The topic for today’s podcast is Hepatic Inflammation and Metabolic Dysfunction-Associated Steatohepatitis. My guest is Alina M. Allen, M.D., M.S., from the Division of Gastroenterology and Hepatology at the Mayo Clinic. What are the risk factors for this health problem? Should we be screening patients for its presence and how should it be managed. These are just some of the topics we’ll discuss in this podcast.
These talks on Inflammation and Cardiometabolic Disease are sponsored by Novo Nordisk