Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review

doi:10.1016/j.obpill.2024.100142

Review

. 2024 Oct 10:12:100142.

doi: 10.1016/j.obpill.2024.100142. eCollection 2024 Dec.

Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review

Prajith Raj Ramesh¹, Priya Krishnan², Samyuktha Prabu³, Varshini Srinivasan³, Varalakshmi Niranjan⁴

Affiliations

¹ Department of Gastroenterology and Hepatology, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, USA.
² Department of Medicine, University of Louisville, Chief of Medicine, RRVAMC, University of Louisville, 550 South Jackson Street, 3rd Floor, Ste. A3K00, Louisville, KY, 40202, USA.
³ Department of Endocrinology, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, USA.
⁴ Department of Medicine, University of Connecticut, Farmington Avenue, Farmington, 06030, USA.

PMID: 39498281
PMCID: PMC11532278
DOI: 10.1016/j.obpill.2024.100142

Review

Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review

Prajith Raj Ramesh et al. Obes Pillars. 2024.

. 2024 Oct 10:12:100142.

doi: 10.1016/j.obpill.2024.100142. eCollection 2024 Dec.

Authors

Prajith Raj Ramesh¹, Priya Krishnan², Samyuktha Prabu³, Varshini Srinivasan³, Varalakshmi Niranjan⁴

Affiliations

¹ Department of Gastroenterology and Hepatology, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, USA.
² Department of Medicine, University of Louisville, Chief of Medicine, RRVAMC, University of Louisville, 550 South Jackson Street, 3rd Floor, Ste. A3K00, Louisville, KY, 40202, USA.
³ Department of Endocrinology, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, USA.
⁴ Department of Medicine, University of Connecticut, Farmington Avenue, Farmington, 06030, USA.

PMID: 39498281
PMCID: PMC11532278
DOI: 10.1016/j.obpill.2024.100142

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of obesity and metabolic syndrome. It is mainly caused by insulin resistance. With the increased risk of visceral obesity in South Asians, the prevalence of MASLD is on the rise. The morbidity associated with MASLD and its complications, including hepatocellular carcinoma is projected to increase in this South Asian population.

Methods: In this narrative review we explore the diagnosis and management of MASLD in the South Asian population. We summarize the findings from the recent literature on the diagnostic methods and management options for MASLD in this population.

Results: Through our search we found no specific guidelines for the diagnosis and management of MASLD in the South Asian population. The existing general guidelines may not be applied to South Asian populations due to the differences in phenotype, genotype, social and cultural aspects. South Asian countries also have limited resources with the non-availability of newer pharmacotherapeutic agents.

Conclusion: The goal of this review is to guide obesity physicians and primary care providers to have a stepwise approach to treat patients at risk for MASLD with a main focus on interdisciplinary management most applicable to South Asian patients. More research is needed to formulate guidelines and algorithm that are specific for the South Asian population.

Keywords: FIB-4; Lean obesity; Liver fibrosis; Metabolic dysfunction-associated steatotic liver disease; Sarcopenia.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Cardiometabolic criteria for MASLD in adults.

**Fig. 2**
Classification of steatotic liver disease (SLD).

See this image and copyright information in PMC

References

1. Rinella M.E., Lazarus J.V., Ratziu V., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966. doi: 10.1097/HEP.0000000000000520. - DOI - PMC - PubMed
1. Quek J., Chan K.E., Wong Z.Y., et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20–30. doi: 10.1016/S2468-1253(22)00317-X. - DOI - PubMed
1. NAFLD and cardiovascular diseases: a clinical review | Clinical Research in Cardiology. https://link.springer.com/article/10.1007/s00392-020-01709-7 - DOI - PMC - PubMed
1. Medina-Julio D., Ramírez-Mejía M.M., Cordova-Gallardo J., Peniche-Luna E., Cantú-Brito C., Mendez-Sanchez N. From liver to brain: how MAFLD/MASLD impacts cognitive function. Med Sci Monit Int Med J Exp Clin Res. 2024;30 doi: 10.12659/MSM.943417. 1-e943417-13. - DOI - PMC - PubMed
1. Mantovani A., Petracca G., Beatrice G., Csermely A., Tilg H., Byrne C.D., et al. Non-alcoholic fatty liver disease and increased risk of incident extrahepatic cancers: a meta-analysis of observational cohort studies. Gut. 2022;71(4):778–788. - PubMed

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[1] Rinella M.E., Lazarus J.V., Ratziu V., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966. doi: 10.1097/HEP.0000000000000520. - DOI - PMC - PubMed

[2] Rinella M.E., Lazarus J.V., Ratziu V., et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966. doi: 10.1097/HEP.0000000000000520. - DOI - PMC - PubMed

[3] Quek J., Chan K.E., Wong Z.Y., et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20–30. doi: 10.1016/S2468-1253(22)00317-X. - DOI - PubMed

[4] Quek J., Chan K.E., Wong Z.Y., et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20–30. doi: 10.1016/S2468-1253(22)00317-X. - DOI - PubMed

[5] NAFLD and cardiovascular diseases: a clinical review | Clinical Research in Cardiology. https://link.springer.com/article/10.1007/s00392-020-01709-7 - DOI - PMC - PubMed

[6] NAFLD and cardiovascular diseases: a clinical review | Clinical Research in Cardiology. https://link.springer.com/article/10.1007/s00392-020-01709-7 - DOI - PMC - PubMed

[7] Medina-Julio D., Ramírez-Mejía M.M., Cordova-Gallardo J., Peniche-Luna E., Cantú-Brito C., Mendez-Sanchez N. From liver to brain: how MAFLD/MASLD impacts cognitive function. Med Sci Monit Int Med J Exp Clin Res. 2024;30 doi: 10.12659/MSM.943417. 1-e943417-13. - DOI - PMC - PubMed

[8] Medina-Julio D., Ramírez-Mejía M.M., Cordova-Gallardo J., Peniche-Luna E., Cantú-Brito C., Mendez-Sanchez N. From liver to brain: how MAFLD/MASLD impacts cognitive function. Med Sci Monit Int Med J Exp Clin Res. 2024;30 doi: 10.12659/MSM.943417. 1-e943417-13. - DOI - PMC - PubMed

[9] Mantovani A., Petracca G., Beatrice G., Csermely A., Tilg H., Byrne C.D., et al. Non-alcoholic fatty liver disease and increased risk of incident extrahepatic cancers: a meta-analysis of observational cohort studies. Gut. 2022;71(4):778–788. - PubMed

[10] Mantovani A., Petracca G., Beatrice G., Csermely A., Tilg H., Byrne C.D., et al. Non-alcoholic fatty liver disease and increased risk of incident extrahepatic cancers: a meta-analysis of observational cohort studies. Gut. 2022;71(4):778–788. - PubMed

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Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review

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Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review

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