Editor's note: The Combined GlHep&SHC 2024 will be held in Singapore from July 25th to 28th, 2024. This conference brings together elite scholars in the field of liver disease from around the world to discuss the latest developments, challenges, and opportunities in liver disease. Hepatology Digest invited Dr Vincent Wong from The Chinese University of Hong Kong to conduct in-depth discussions on the epidemiology of metabolic associated fatty liver disease (MAFLD), lean MAFLD, and other related issues.Hepatology Digest: Can you share the current global prevalence of fatty liver disease, especially MAFLD? What are the latest data supporting this, and how have the trends changed compared to the past?
Dr Wong: The epidemiology of MAFLD is evolving. The most comprehensive data come from a recent systematic review and meta-analysis conducted by Dr. Younossi ‘s team. Their findings indicate that the prevalence of MAFLD in the general adult population is now close to 38%. This is a significant increase from about 20% twenty years ago. This rise correlates with an increase in cases of cirrhosis, end-stage liver disease, and liver cancer associated with NAFLD. It’s an alarming trend that demands attention.
Hepatology Digest: What are the clinical differences between lean MAFLD patients and those who are obese? How does their treatment differ?
Dr Wong: Interestingly, while MAFLD is strongly linked to obesity and metabolic risk factors, approximately 10-20% of individuals with MAFLD are classified as lean, with a body mass index (BMI) of less than 25 in general or less than 23 in the Asian population. Lean individuals generally have less severe MAFLD, but they can still develop steatohepatitis and advanced fibrosis. In terms of management, the assessment methods are quite similar; we use the same non-invasive tests to evaluate disease severity. Lifestyle modification remains effective, with a dose-response relationship between weight reduction and liver disease improvement. Lean individuals don’t need to lose as much weight to achieve similar benefits as their overweight and obese counterparts.
Hepatology Digest: Given that patients with lean MAFLD often do not show significant clinical symptoms or abnormal BMI levels, routine screening is not usually performed. How can we timely detect and treat MAFLD in these patients?
Dr Wong: Currently, there is no data to support population-wide screening for MAFLD, regardless of metabolic profile. For lean individuals without any risk factors or abnormalities, I would not recommend routine assessment for MAFLD. However, if an individual has other cardiometabolic risk factors, particularly type 2 diabetes, it may be prudent to evaluate for liver disease. Additionally, if someone presents with abnormal liver biochemistry or non-invasive test results suggestive of advanced liver disease, a thorough workup is necessary.”
