Expert Consensus on Improving Clinical Approaches to Managing Liver Diseases in Patients with Comorbidities
Abstract
Non-alcoholic fatty liver disease affects up to 38% of the adult population worldwide, making it the most common chronic liver disease. It is a multisystem pathology, which is caused by systemic insulin resistance and related metabolic dysfunction, and lead to steatosis, steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma, as well as to extrahepatic complications such as cardiovascular diseases, type 2 diabetes mellitus and chronic kidney disease. In 2023 the main international liver study associations have proposed to replace the term “non-alcoholic fatty liver disease” with “metabolic associated fatty liver disease” (MAFLD) to better reflect the metabolic origin of the disease. This change in terminology sparked greater scientific interest and a reassessment of clinical strategies. In March 2024, an Expert Forum on “Clinical Improvement of Approaches to Treating Liver Diseases in Comorbid Patients” brought together 16 key expert specialists of different specialities from Ukraine, Kazakhstan, Uzbekistan, Kyrgyzstan, Georgia, and Armenia. The forum focused on optimizing the treatment of MAFLD in patients with comorbid diseases. The consensus was adopted on the main recommendations: early diagnosis using modern imaging methods; lifestyle modification (diet and physical activity); pharmacotherapy; in some cases, bariatric surgery. Special attention was paid to the treatment of comorbidities, hepatogenic fatigue with ademetionine and the use of the Charlson index for survival prognosis. The document emphasizes the importance of a multidisciplinary approach, the need for further studies of pathogenesis and the development of targeted therapy. Implementation of these recommendations may improve the quality of life and long-term outcomes for patients with chronic liver disease. Conclusions. MAFLD is characterized by the accumulation of fat in the liver due to metabolic disorders. It is a common disease worldwide. Early diagnosis of the disease is vital because it can progress to severe and terminal conditions (steatohepatitis, cirrhosis, and liver cancer). Therapeutic strategies include: lifestyle changes, pharmacotherapy, and bariatric surgery. Further studies are needed to improve the understanding of the pathogenesis of MAFLD, identify biomarkers of this disease, and develop new therapeutic strategies.