Nonalcoholic fatty liver disease (NAFLD) is a clinicopathological syndrome characterized by excessive fat deposition in hepatocytes, excluding alcohol and other clear liver damaging factors. It is an acquired metabolic stress-induced liver injury closely related to insulin resistance and genetic susceptibility. It includes simple fatty liver (SFL), nonalcoholic steatohepatitis (NASH), and related cirrhosis. With the global epidemic trend of obesity and its related metabolic syndrome, nonalcoholic fatty liver disease has become an important cause of chronic liver disease in Europe and the United States. The prevalence of NAFLD in ordinary adults is 10% ~ 30%, of which 10% ~ 20% are Nash, and the incidence of liver cirrhosis in the latter is as high as 25% within 10 years.
In 2020, nonalcoholic fatty liver disease (NAFLD) was renamed metabolism-related fatty liver disease (MAFLD). NAFLD originated from the false diagnosis of alcoholic steatohepatitis (ash) in obese and diabetes patients by Mayo diagnostic pathologists in 1980. After that, the expert communicated with the clinician and added the word "not" before diagnosis, that is, Nash. "The original naming and exclusive diagnosis of the disease were misleading. NAFLD should not only consider the impact of drinking on it."
"In 2019, a survey was conducted by 31 experts from 15 countries initiated by Australian scholars. These experts all thought that the original name was inappropriate and suggested changing it. Each expert wrote 5-10 names and then voted."
"72.4% of the people think that it should be changed to metabolic-related fatty liver disease/hepatitis. At the same time, these experts agree that the diagnosis of metabolic-related fatty liver disease is no longer an exclusive diagnosis, and metabolic-related fatty liver disease can coexist with other liver diseases. Therefore, we have seen the statement of this expert in 2020, and finally changed its name to MAFLD."
The global prevalence of NAFLD
The global prevalence of NAFLD varies greatly, with the highest in North America and the lowest in Africa. In recent years, the prevalence of fatty liver in China is also increasing. The analysis shows that the prevalence rate of NAFLD among HIV-infected people is 35%. Even among slim people, MAFLD still has a high incidence. A study on thin people with HIV infection in Clinical Infectious Disease used transient elastography to screen fatty liver in 1511 cases of HIV infection in Canada. The results showed that the prevalence rate of NAFLD in thin people with HIV infection was 24%, and 16% of thin people with fatty liver had significant liver fibrosis.
Using tesamorelin can effectively improve NAFLD and HIV infected
Studies have shown that 35% of patients treated with Tesamorelin for one year have lost their liver steatosis, and the progress of liver fibrosis has been effectively prevented. Compared with placebo, Tesamorelin did not significantly improve the activity score of fatty liver disease and significantly reduce the levels of ALT, GGT, and blood lipid. In another study, when the subjects took vitamin E orally for 24W, fatty liver was obviously improved, but there was no significant effect on blood lipid and homeostasis model insulin resistance index (HOMA-IR). A comparative study on the use of statins and placebo for 96 weeks shows that the degree of fatty liver in both groups has progressed. However, there is no specific medicine for HIV complicated with fatty liver. We can only adjust the diet, take more exercise, and take certain lipid-lowering or liver-protecting treatments if necessary. If the situation is serious, we can consult the doctor about whether to replace antiviral drugs.
Recently, in a research paper published in the international journal JAMA, researchers from Massachusetts General Hospital and other places found that Tesamorelin, a hormone analog released by growth hormone, may significantly reduce the risk of fatty liver disease in HIV-infected people.GHRH analog Temorelin acetate was approved by FDA to reduce abdominal adiposity in HIV patients with fat metabolism disorder.
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