MASLD: a systemic metabolic disorder with cardiovascular and malignant complications

• Published in: Gut Vol. 73; no. 4; pp. 691 - 702
• Main Authors: Targher, Giovanni, Byrne, Christopher D, Tilg, Herbert
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 16.01.2024; BMJ Publishing Group LTD
• Subjects: Adult; Adults; Biobanks; CANCER; Cardiac arrhythmia; CARDIOVASCULAR COMPLICATIONS; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cirrhosis; Cohort analysis; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Disease resistance; Epidemiology; Fatty liver; Heart failure; Hepatocellular carcinoma; Histology; Humans; Insulin resistance; Kidney diseases; LIVER; Liver cancer; Liver cirrhosis; Liver diseases; Liver Neoplasms - etiology; Medical screening; Meta-analysis; Metabolic Diseases - complications; Metabolic disorders; Metabolism; Middle age; Mortality; Non-alcoholic Fatty Liver Disease - complications; NONALCOHOLIC STEATOHEPATITIS; Recent advances in clinical practice; Risk factors; United Kingdom > UK; CARDIOVASCULAR COMPLICATIONS; NONALCOHOLIC STEATOHEPATITIS; CANCER; LIVER
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2023-330595

Non-alcoholic fatty liver disease (NAFLD) has rapidly become the most common chronic liver disease globally and is currently estimated to affect up to 38% of the global adult population. NAFLD is a multisystem disease where systemic insulin resistance and related metabolic dysfunction play a pathogenic role in the development of NAFLD and its most relevant liver-related morbidities (cirrhosis, liver failure and hepatocellular carcinoma) and extrahepatic complications, such as cardiovascular disease (CVD), type 2 diabetes mellitus, chronic kidney disease, and certain types of extrahepatic cancers. In 2023, three large multinational liver associations proposed that metabolic dysfunction-associated steatotic liver disease (MASLD) should replace the term NAFLD; the name chosen to replace non-alcoholic steatohepatitis was metabolic dysfunction-associated steatohepatitis (MASH). Emerging epidemiological evidence suggests an excellent concordance rate between NAFLD and MASLD definitions—that is, ~99% of individuals with NAFLD meet MASLD criteria. In this narrative review, we provide an overview of the literature on (a) the recent epidemiological data on MASLD and the risk of developing CVD and malignant complications, (b) the underlying mechanisms by which MASLD (and factors strongly linked with MASLD) may increase the risk of these extrahepatic complications and (c) the diagnosis and assessment of CVD risk and potential treatments to reduce CVD risk in people with MASLD or MASH.