Actualización del Hígado Graso a la Enfermedad Hepática Metabólica (MASLD)

José Antonio Moreno Araya
Servicio de Gastroenterología, Hospital Clínica Bíblica, Costa Rica..

Ana Lucia Mayorga Álvarez
Peace Corps Medical Officer, Peace Corps Costa Rica.

Ignacio Montealegre Lobo
Peace Corps Medical Officer, Peace Corps Costa Rica.

Resumen

La enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD) es una de las principales causas de morbi-mortalidad hepática, afectando aproximadamente al 30% de la población global, con mayor prevalencia en Latinoamérica. La MASLD puede evolucionar hacia esteatohepatitis no alcohólica (NASH), fibrosis hepática y carcinoma hepatocelular, lo que genera una creciente preocupación por sus implicaciones en la salud pública. El diagnóstico se basa en la identificación de esteatosis hepática mediante biopsia o imágenes radiológicas, junto con la presencia de al menos un factor de riesgo cardio-metabólico, como resistencia a la insulina o dislipidemia. La severidad de la fibrosis hepática se relaciona con la mortalidad, y recientemente se han incorporado técnicas no invasivas como el índice Fibrosis-4 (FIB-4) y la elastografía transitoria para su evaluación.

La fisiopatología de la MASLD implica la acumulación de lípidos en los hepatocitos, predisponiendo a la destrucción celular y a la fibrosis. Factores como la obesidad y la diabetes tipo 2 tienen un impacto mayor en la progresión de la enfermedad. El tratamiento de la MASLD debe ser integral, enfocándose en la modificación del estilo de vida, con especial énfasis en la pérdida de peso y la mejora de la dieta. Se han identificado varias intervenciones terapéuticas, como la vitamina E, pioglitazona y GLP-1, que han mostrado eficacia en la mejora de la esteatosis y la fibrosis. No obstante, es fundamental continuar investigando y desarrollando estrategias terapéuticas para abordar este creciente problema de salud y sus complicaciones asociadas.

Palabras claves

Enfermedad Hepática Esteatósica, Riesgo Cardiovascular, Fibrosis Hepática, Diabetes Mellitus Tipo 2, Obesidad.

Abstract

The metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the leading causes of liver-related morbidity and mortality, affecting approximately 30% of the global population, with a higher prevalence in Latin America. MASLD can progress to non-alcoholic steatohepatitis (NASH), hepatic fibrosis, and hepatocellular carcinoma, raising increasing concern about its implications for public health. Diagnosis is based on the identification of hepatic steatosis via biopsy or radiological imaging, along with the presence of at least one cardiometabolic risk factor, such as insulin resistance or dyslipidemia. The severity of hepatic fibrosis is correlated with mortality, and non-invasive techniques such as the Fibrosis-4 index (FIB-4) and transient elastography have recently been incorporated for its evaluation.

The pathophysiology of MASLD involves the accumulation of lipids in hepatocytes, which predisposes to cellular destruction and fibrosis. Factors such as obesity and type 2 diabetes have a greater impact on disease progression. The management of MASLD should be comprehensive, focusing on lifestyle modifications, with special emphasis on weight loss and changes in diet. Several therapeutic interventions, such as vitamin E, pioglitazone, and GLP-1, have been identified as effective in improving steatosis and fibrosis. However, it is essential to continue researching and developing therapeutic strategies to address this growing health issue and its associated complications.

Keywords

Hepatic Steatosis, Cardiovascular Risk, Liver Fibrosis, Type 2 Diabetes Mellitus, Obesity.

Bibliografía

1. Soto A, Spongberg C, Martinino A, Giovinazzo F. Exploring the Multifaceted Landscape of MASLD: A Comprehensive Synthesis of Recent Studies, from Pathophysiology to Organoids and Beyond. Vol. 12, Biomedicines. Multidisciplinary Digital Publishing Institute (MDPI); 2024.

2. Meroni M, Chiappori F, Paolini E, Longo M, De Caro E, Mosca E, et al. A novel gene signature to diagnose MASLD in metabolically unhealthy obese individuals. Biochem Pharmacol. 2023 Dec 1;218.

3. Pelusi S, Ronzoni L, Rondena J, Rosso C, Pennisi G, Dongiovanni P, et al. Prevalence and Determinants of Liver Disease in Relatives of Italian Patients With Advanced MASLD. Clinical Gastroenterology and Hepatology. 2024;

4. Nemer M, Osman F, Said A. Dietary macro and micronutrients associated with MASLD: Analysis of a national US cohort database. Ann Hepatol. 2024 May 1;29(3).

5. Bilson J, Mantovani A, Byrne CD, Targher G. Steatotic liver disease, MASLD and risk of chronic kidney disease. Vol. 50, Diabetes and Metabolism. Elsevier Masson s.r.l.; 2024.

6. Shi Y, Taherifard E, Saeed A, Saeed A. MASLD-Related HCC: A Comprehensive Review of the Trends, Pathophysiology, Tumor Microenvironment, Surveillance, and Treatment Options. Vol. 46, Current Issues in Molecular Biology. Multidisciplinary Digital Publishing Institute (MDPI); 2024. p. 5965–83.

7. .Phoolchund AGS, Khakoo SI. MASLD and the Development of HCC: Pathogenesis and Therapeutic Challenges. Vol. 16, Cancers. Multidisciplinary Digital Publishing Institute (MDPI); 2024.

8. Chan WK, Chuah KH, Rajaram RB, Lim LL, Ratnasingam J, Vethakkan SR. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. Vol. 32, Journal of Obesity and Metabolic Syndrome. Korean Society for the Study of Obesity; 2023. p. 197–213.

9. Medina-Julio D, Ramírez-Mejía MM, Cordova-Gallardo J, Peniche-Luna E, Cantú-Brito C, Méndez-Sánchez N. From Liver to Brain: How MAFLD/MASLD Impacts Cognitive Function. Vol. 30, Medical Science Monitor. International Scientific Information, Inc.; 2024.

10. Lee BP, Dodge JL, Terrault NA. National prevalence estimates for steatotic liver disease and subclassifications using consensus nomenclature. Hepatology. 2024 Mar 1;79(3):666–73.

11. Méndez-García LA, Escobedo G, Baltazar-Pérez I, Ocampo-Aguilera NA, Arreola-Miranda JA, Cid-Soto MA, et al. Exploring the Th2 Response in Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Potential Modulator of the Renin-Angiotensin System (RAS) Pathway in Hypertension Development. Life. 2024 Aug 29;14(9):1080.

12. Tacke F, Horn P, Wai-Sun Wong V, Ratziu V, Bugianesi E, Francque S, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024 Sep 1;81(3):492–542.

13. Sigrist RMS, Liau J, Kaffas A El, Chammas MC, Willmann JK. Ultrasound elastography: Review of techniques and clinical applications. Vol. 7, Theranostics. Ivyspring International Publisher; 2017. p. 1303–29.

14. Zhang L, Shi Y, Liang B, Li X. An overview of the cholesterol metabolism and its proinflammatory role in the development of MASLD. Hepatol Commun. 2024 May;8(5).

15. Godoy-Matos AF, Valério CM, Silva Júnior WS, de Araujo-Neto JM, Bertoluci MC. 2024 UPDATE: the Brazilian Diabetes Society position on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) in people with prediabetes or type 2 diabetes. Vol. 16, Diabetology and Metabolic Syndrome. BioMed Central Ltd; 2024.

16. Chandrasekaran P, Weiskirchen R. The Role of Obesity in Type 2 Diabetes Mellitus—An Overview. Vol. 25, International Journal of Molecular Sciences. Multidisciplinary Digital Publishing Institute (MDPI); 2024.

17. Balogun O, Wang JY, Shaikh ES, Liu K, Stoyanova S, Memel ZN, et al. Effect of combined tobacco use and type 2 diabetes mellitus on prevalent fibrosis in patients with MASLD. Hepatol Commun. 2023 Nov 1;7(11):E0300.

18. Huttasch M, Roden M, Kahl S. Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? Vol. 157, Metabolism: Clinical and Experimental. W.B. Saunders; 2024.

19. Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocrine Practice. 2022 May 1;28(5):528–62.

20. Sancar G, Birkenfeld AL. The role of adipose tissue dysfunction in hepatic insulin resistance and T2D. Vol. 262, Journal of Endocrinology. BioScientifica Ltd.; 2024.

21. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023 May 1;77(5):1797–835.

22. Mollace R, Longo S, Nardin M, Tavernese A, Musolino V, Cardamone A, et al. Role of MASLD in CVD: A review of emerging treatment options. Vol. 217, Diabetes Research and Clinical Practice. Elsevier Ireland Ltd; 2024.

23. Wu H, Wei J, Wang S, Chen L, Zhang J, Wang N, et al. Dietary pattern modifies the risk of MASLD through metabolomic signature. JHEP Reports. 2024 Aug 1;6(8).

24. OrliacqJ,Pérez-CornagoA,ParrySA,KellyRK,KoutoukidisDA,Carter JL. Associations between types and sources of dietary carbohydrates and liver fat: a UK Biobank study. BMC Med. 2023 Dec 1;21(1).

25. Ciardullo S, Muraca E, Vergani M, Invernizzi P, Perseghin G. Advancements in pharmacological treatment of NAFLD/MASLD: a focus on metabolic and liver-targeted interventions. Vol. 12, Gastroenterology Report. Oxford University Press; 2024.

26. Alboraie M, Butt AS, Piscoya A, Dao Viet H, Hotayt B, Al Awadhi S, et al. Why MASLD Lags Behind MAFLD: A Critical Analysis of Diagnostic Criteria Evolution in Metabolic Dysfunction-Associated Liver Diseases. Vol. 30, Medical Science Monitor. International Scientific Information, Inc.; 2024.