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Author Spotlight: Establishing MASLD Cell Models for Investigating Disease Mechanisms and the Lipid-Lowering Effects of Koumiss
Published on: July 19, 2024
METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE - ASSESSMENT OF PATIENTS WITH OBESITY AND METABOLIC SYNDROME
Leonardo Halamy Pereira1, Fernando de Barros1, Thais Guaraná de Andrade2
1Universidade Federal Fluminense, Department of Specialized and General Surgery - Niterói (RJ), Brazil.
Background:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in the world and was recently renamed to emphasize its metabolic component.
Aims:
This article seeks to fill the gap in specific guidelines for patients with obesity and MASLD who will undergo bariatric surgery.
Methods:
A systematic search for guidelines was carried out on PubMed and Embase platforms.
Results:
A total of 544 articles were found, of which 11 were selected according to inclusion and exclusion criteria. All 11 guidelines are from clinical societies; therefore, they do not include some necessary interpretations for bariatric patients.
Conclusions:
We recommend that every patient undergoing bariatric and metabolic surgery be screened initially with the Fibrosis-4 (FIB-4) score, followed by transient hepatic elastography (vibration-controlled transient elastography, VCTE), especially for those with FIB-4>1.3. However, interpreting VCTE results in obese patients requires further studies to define the actual cutoff values. Enhanced Liver Fibrosis® shows promise but its availability is limited. The indication for liver biopsy during surgery needs to be individualized but it is recommended for those with changes in FIB-4 and/or VCTE. Family screening is recommended for relatives of young patients with already advanced fibrosis. Liver transplantation is an option for patients with advanced MASLD but the optimal timing for bariatric surgery with transplantation is still unclear. Regular follow-up and VCTE examination are recommended to monitor disease progression after surgery.
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