MASLD: a systemic metabolic disorder with cardiovascular and malignant complications

Jan 16, 2024Gut

MASLD as a whole-body metabolic disease linked to heart problems and cancer

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Abstract

Up to 38% of the global adult population is estimated to be affected by non-alcoholic fatty liver disease (NAFLD).

NAFLD is associated with systemic insulin resistance and metabolic dysfunction, contributing to liver-related diseases such as cirrhosis and liver failure.
It is linked to extrahepatic complications, including cardiovascular disease, type 2 diabetes, chronic kidney disease, and specific cancers.
Emerging evidence suggests that nearly 99% of individuals with NAFLD meet the criteria for metabolic dysfunction-associated steatotic liver disease (MASLD).
Recent proposals recommend replacing NAFLD with MASLD and the term non-alcoholic steatohepatitis with metabolic dysfunction-associated steatohepatitis (MASH).
The review discusses the epidemiological data on MASLD and its correlation with increased risks of cardiovascular and malignant complications.

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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.

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MASLD: a systemic metabolic disorder with cardiovascular and malignant complications

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