A clinical case of fatty liver disease. How the new nomenclature can be applied in practice

Abstract

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is an urgent problem, as this condition is diagnosed in about 35% of the world’s population. Manifestations of metabolic dysfunction in MASLD include excessive body weight (abdominal obesity is the most dangerous), manifestations of dyslipidemia, hepatomegaly, signs of diabetes, arterial hypertension, and moderate alcohol consumption (> 20 g/30 g of alcohol per day in women and men, respectively). According to a new meta‑analysis, MASLD significantly increases the risk of cardiovascular, metabolic, oncological and reproductive consequences. This disorder was associated with a significantly increased risk of cardiovascular outcomes (hazard ratio [HR], 1.43), metabolic outcomes such as incident hypertension (HR, 1.75), prediabetes (HR, 1.69), diabetes (HR, 2.56) and metabolic syndrome (HR, 2.57), chronic kidney disease (HR, 1.38), and various liver‑related outcomes (HR, 3.92). MASLD is also associated with all types of cancer (HR, 1.54); the highest risk is observed for hepatocellular carcinoma (HR, 4.37). Currently, there are no FDA‑approved drugs for the treatment of MASLD, but there are some drugs to treat comorbidities with potential benefit in MASLD that may be considered in the appropriate clinical setting. It is important to understand that MASLD is a complex and multifaceted condition that requires a comprehensive approach to diagnostics and treatment, in addition to the approach of a gastroenterologist‑hepatologist alone. The increasing MASLD prevalence will remain a major global health threat that requires the implementation of effective mechanisms of the disease management.
 The authors present a clinical case of metabolic dysfunction‑associated steatohepatitis, associated with the I degree obesity. Liver dysfunction, metabolic and asthenovegetative disorders were revealed on the basis of complaints, anthropometric and anamnestic data, and the results of laboratory studies. Treatment with the use of S‑adenosylmethionine (Agepta, manufactured by Italy, developed by the company Omnifarma, Ukraine) was proposed, which contributed to the stabilization of indicators, according to the data of repeated clinical examinations. The lifestyle changes, physical activity, compliance to the treatment scheme and doctor’s recommendations enabled improving the patient’s state of health.