Review Article
Volume 9 Issue 4 - 2022
View of the Non-Alcoholic Fatty Liver in Non-Obese Patients from MAFLD Perspective
Michel González Sánchez*
Msc in Bioethics, Family Medicine Specialist, MINSAP, Cuba
*Corresponding Author: Michel González Sánchez, 1st Degree Specialist in Family Medicine, Master in Bioethics from the “San Vicente Martir” University of Valencia, Diploma in Internal Medicine, Member of the Global Liver Institute and the American Liver Foundation, United European Gastroenterology Associate Medical, Santa Clara, Villa Clara, Cuba.
Received: February 22, 2022; Published: March 16, 2021




Abstract

Background: A novel concept consensus by an international panel of experts recommended a change in name for NAFLD to metabolic (dysfunction) associated fatty liver disease (MAFLD). The new definition is a landmark in hepatology bringing a new way of thinking about diseases of the liver that are associated with fat deposition and metabolic dysfunction Importantly, this “MAFLD definition” avoid the dichotomous view of NAFL and NASH, since it is based in “positive” criterion (evidence of hepatic steatosis) instead of “negative” criterion hard to exclude. Lean NAFLD is defined as hepatic steatosis with a BMI < 25 kg/m2 in non-Asian people or BMI < 23 kg/m2 in Asians.

At present, it is not possible to define a phenotype of Metabolic Healthy Obesity (MHO) due to the lack of consensus. This disparity is due to the difference in defining metabolic health found by some authors when studying the phenotypes of subjects with unhealthy metabolic weight. We generally associate the development of NAFLD Patients with Obesity, but in opposition to this, lean patients can also develop this disease, especially when we find visceral obesity associated with a strong genetic predisposition and an altered and unhealthy diet pattern.

Here is the importance of addressing important concepts such as metabolic unhealthy normal weight, MUHO, MHO, as well as the interrelationship that all of them have with the distribution of body fat.

For this reason, for the sake of understanding and finding a clinical-pathophysiological relationship of the disease, I try to follow a route which helps me to better understand said relationship of importance in the study of Metabolic Association of Fatty Liver. It is essential to start from the term MAFLD which follows 2 routes, one in obese patients and the other in non-obese patients.

Conclusion: Adequate understanding of the spectrum of MAFLD in association with non-obese NAFLD constitutes a new line of research which would provide a better and more exhaustive understanding of the relationship between metabolic dysfunction and fatty liver disease, especially in non-obese patients in any of It would be necessary to delve further in non-Asian patients to establish a better characterization of the disease. In another order, it is very important to establish clinical criteria in correlation with the pathophysiological pathways of the disease. This will allow a greater approach and management of the patient with this type of condition, giving us benefits beyond the simple understanding that until now we have had about the fatty liver.

Keywords: MAFLD; Lean NAFLD; Lean MAFLD; Non obese NAFLD; MHNW and MONW

References

    clinical outcomes of nonalcoholic fatty liver disease in nonobese patients”. Hepatology1 (2017): 54-64.
  1. N Stefan., et al. "Causes, Characteristics, and Consequences of Metabolically Unhealthy Normal Weight in Humans”. Cell Metabolism 2 (2017): 292-300.
  2. N Stefan. "Causes, consequences, and treatment of metabolically unhealthy fat distribution”. Lancet Diabetes and Endocrinology 7 (2020): 616-627.
  3. M Shefi Kuchay., et al. "Non-Alcoholic Fatty Liver disease in Lean and Non Obese Individuals: current and Future Challenges”. Biomedicines10 (2021): 1346.
  4. F Chen., et al. "Lean NAFLD: A Distinct Entity Shaped by Differential Metabolic Adaptation”. Hepatology4 (2020): 1213-1227.
  5. M Enjoji., et al. "Nutrition and Nonalcoholic Fatty Liver Disease: The Significance of Cholesterol”. International Journal of Hepatology (2012): 925807.
  6. N Méndez-Sánchez and LE Díaz-Orozco. "Editorial: International Consensus”. Medical Science Monitor 27 (2021): e933860.
  7. NE Rich., et al. "Racial and Ethnic Disparities in Non-alcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis”. Clinical Gastroenterology and Hepatology 16 (2018): 198-210.
  8. RJ Loos and TO Kilpeläinen. "Genes that make you fat, but keep you healthy”. Journal of Internal Medicine 5 (2018): 450-463.
  9. M Shafi Kuchay., et al. "Non-Alcoholic Fatty Liver Disease In lean And Non-Obese Individuals: Current and Future Challenges”. Biomedicines10 (2021): 1346.
  10. H Hagström., et al. "Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: A long-term follow-up study”. Hepatology Communications 1 (2018): 48-57.
  11. S McPherson., et al. "Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis”. American Journal of Gastroenterology 5 (2017): 740-751.
  12. N Chalasani., et al. "The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases”. Hepatology1 (2018): 328-357.
  13. European Association for the Study of the Liver (E, European Association for the Study of Diabetes and European Association for the Study of Obesity. "EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease”. Journal of Hepatology6 (2016): 1388-1402.
  14. AR Guerra-Ruiz., et al. "Biochemical assessment of metabolic associated fatty liver disease”. Advances in Laboratory Medicine 2 (2020).
  15. M Eslam., et al. "Toward More Accurate Nomenclature for Fatty Liver Diseases”. Gastroenterology3 (2019): 590-593.
  16. S Pelusi., et al. "Prevalence and Risk Factors of Significant Fibrosis in Patients with Nonalcoholic Fatty Liver Without Steatohepatitis”. Clinical Gastroenterology and Hepatology 11 (2019): 2310-2319.
  17. N Stefan. "Metabolically Healthy and Unhealthy Normal Weight and Obesity”. Endocrinology and Metabolism 3 (2020): 487-493.
  18. S Gómez-Zorita., et al. "Metabolically healthy obesity and metabolically obese normal weight: a review”. Journal of Physiology and Biochemistry1 (2021): 175-189.
  19. M Eslam., et al. "Genetics and epigenetics of NAFLD and NASH: Clinical impact”. Hepatology2 (2018): 268-279.
  20. M Blüher. "Are metabolically healthy obese individuals really healthy?”. European Journal of Endocrinology 6 (2014): R209-R219.
  21. AD Karelis and R Rabasa-LLoret. "Obesity: Can inflammatory status define metabolic health?”. Nature Reviews Endocrinology 12 (2013): 694-695.
  22. T McLaughlin., et al. "Enhanced proportion of small adipose cells in insulin-resistant vs insulin-sensitive obese individuals implicates impaired adipogenesis”. Diabetologia8 (2007): 1707-1715.
  23. F Badoud., et al. "Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals”. FASEB Journal3 (2015): 748-758.
  24. I Brandão and M João Martins. "Metabolically Healthy Obesity-Heterogeneity in Definitions and Unconventional Factors”. Metabolites2 (2020): 48.
  25. CG Goncalves., et al. "Metabolically healthy obese individuals: Key protective factors”. Nutrition1 (2016): 14-20.
  26. FM Wensveen and S Valentić. "The "Big Bang" in obese fat: Events initiating obesity-induced adipose tissue inflammation”. European Journal of Immunology 9 (2015): 2446-2456.
  27. CM Philips and IJ Perry. "Does inflammation determine metabolic health status in obese and nonobese adults?”. Journal of Clinical Endocrinology and Metabolism10 (2013): E1610-E1619.
  28. G Duprat Ceniccola., et al. "Current technologies in body composition assessment: advantages and disadvantages”. Nutrition 62 (2019): 25-31.
  29. W Pluta and W Dudzi´ nska. "Metabolic Obesity in People with Normal Body Weight (MONW)-Review of Diagnostic Criteria”. International Journal of Environmental Research 2 (2022): 624.
  30. C Ding., et al. "Lean, but not healthy: the 'metabolically obese, normal-weight' phenotype”. Current Opinion in Clinical Nutrition and Metabolic Care 6 (2016): 408-417.
  31. R Tian-Yi and F Jian-Gao. "What are the clinical settings and outcomes of lean NAFLD?”. Gastroenterology and Hepatology5 (2021): 289-290.
  32. LB VanWagner and M Armstrong. "Lean NAFLD: A Not So Benign Condition?”. Hepatology Communications 2.1 (2018): 5-8.
  33. LB VanWagner., et al. "Body mass index trajectories in young adulthood predict non-alcoholic fatty liver disease in middle age: The CARDIA cohort study”. Liver International 4 (2018): 706-714.
Citation: Michel González Sánchez. “View of the Non-Alcoholic Fatty Liver in Non-Obese Patients from MAFLD Perspective”. EC Gastroenterology and Digestive System 9.4 (2022): 36-46.

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