Editor's note: The Combined GlHep&SHC 2024 Conference will be held in Singapore from July 25th to 28th, 2024. Dr. Daniel Huang Qingyao from the National University Hospital of Singapore gave multiple presentations at the meeting. Hepatology Digest invited Dr. Daniel Huang Qingyao to share on metabolic associated fatty liver disease (MAFLD), liver disease examination methods, and other related topics. The following is an interview transcript.Hepatology Digest: Is the etiology of fatty liver disease different in Asian populations compared to European and American populations？ What are the differences between the Asian fatty liver population and the European and American fatty liver populations?
Dr Huang: In terms of etiology, it’s quite similar across populations. The main difference in Asia is the higher proportion of people with fatty liver who have a normal body mass index (BMI). This creates challenges for clinicians because, for obese and overweight individuals, there is a recommendation to screen for liver fibrosis. However, for those with a normal body weight, there isn’t a similar recommendation to screen for advanced liver disease.
Hepatology Digest: What are the unique epidemiological characteristics of fatty liver in Asia, and how do they compare to those in European and American populations? Are there any specific treatment and management recommendations for Asian patients based on their conditions?
Dr Huang: As we’ve discussed, there’s a higher proportion of lean fatty liver cases in Asia. In terms of treatment, the indications are generally the same. The major difficulty in Asia is the lack of available treatments for fatty liver. While resmetirome has been approved in the US, there are currently no plans to introduce this treatment in Asia. Therefore, individuals in Asia must rely on lifestyle modifications, or in severe cases, liver transplantation if they develop decompensated liver disease. This is a significant gap in treatment options in Asia.
Hepatology Digest: Patients with liver disease generally have a low acceptance of liver biopsy. What role does non-invasive testing play in the diagnosis of NAFLD and HCC?
Dr Huang: We are gradually moving towards a world where liver biopsy is rare. In the next five years or so, I envision that non-invasive tests will replace liver biopsy for diagnosing liver conditions. This will be beneficial for both clinical trial development and the management of clinical care.
Hepatology Digest：China’s Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022), which suggest expanding the conditions for antiviral treatment. You also mentioned expanding the treatment indications for chronic hepatitis B in your report. Is there a universal consensus internationally on this expansion, and what benefits does it bring to patients with chronic hepatitis B?
Dr Huang: Currently, treatment indications have been expanded depending on the guidelines. The World Health Organization recently updated its guidelines, stating that individuals with chronic hepatitis B, abnormal ALT levels, and hepatitis B DNA levels over 2000 IU/mL can be considered for treatment. This is a significant step forward, as it expands treatment criteria to include patients who might develop complications from chronic hepatitis B if left untreated. However, regional guidelines are still being updated, and we need to see how each society adapts to these changes.
