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Review
. 2022 May;37(5):795-811.
doi: 10.1111/jgh.15787. Epub 2022 Feb 8.

Malaysian Society of Gastroenterology and Hepatology consensus statement on metabolic dysfunction-associated fatty liver disease

Wah-Kheong Chan  1 , Soek-Siam Tan  2 , Siew-Pheng Chan  3 , Yeong-Yeh Lee  4 , Hoi-Poh Tee  5 , Sanjiv Mahadeva  1 , Khean-Lee Goh  1 , Anis Safura Ramli  6   7 , Feisul Mustapha  8 , Nik Ritza Kosai  9 , Raja Affendi Raja Ali  10
Affiliations
Review

Malaysian Society of Gastroenterology and Hepatology consensus statement on metabolic dysfunction-associated fatty liver disease

Wah-Kheong Chan et al. J Gastroenterol Hepatol. 2022 May.

Abstract

The Malaysian Society of Gastroenterology and Hepatology saw the need for a consensus statement on metabolic dysfunction-associated fatty liver disease (MAFLD). The consensus panel consisted of experts in the field of gastroenterology/hepatology, endocrinology, bariatric surgery, family medicine, and public health. A modified Delphi process was used to prepare the consensus statements. The panel recognized the high and increasing prevalence of the disease and the consequent anticipated increase in liver-related complications and mortality. Cardiovascular disease is the leading cause of mortality in MAFLD patients; therefore, cardiovascular disease risk assessment and management is important. A simple and clear liver assessment and referral pathway was agreed upon, so that patients with more severe MAFLD can be linked to gastroenterology/hepatology care, while patients with less severe MAFLD can remain in primary care or endocrinology, where they are best managed. Lifestyle intervention is the cornerstone in the management of MAFLD. The panel provided a consensus on the use of statin, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, sodium-glucose cotransporter-2 inhibitor, glucagon-like peptide-1 agonist, pioglitazone, vitamin E, and metformin, as well as recommendations on bariatric surgery, screening for gastroesophageal varices and hepatocellular carcinoma, and liver transplantation in MAFLD patients. Increasing the awareness and knowledge of the various stakeholders on MAFLD and incorporating MAFLD into existing noncommunicable disease-related programs and activities are important steps to tackle the disease. These consensus statements will serve as a guide on MAFLD for clinicians and other stakeholders.

Keywords: MAFLD; MSGH; Malaysia; Malaysian Society of Gastroenterology and Hepatology; NAFLD; consensus; metabolic dysfunction-associated fatty liver disease; multi-disciplinary; non-alcoholic fatty liver disease.

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Figures

Figure 1
Figure 1
Definition of metabolic dysfunction‐associated fatty liver disease (MAFLD). BMI, body mass index; HbA1c, glycated hemoglobin; HDL, high‐density lipoprotein; HOMA‐IR, homeostatic model assessment for insulin resistance; hs‐CRP, high‐sensitivity C‐reactive protein. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Algorithm for screening for more severe metabolic dysfunction‐associated fatty liver disease among patients with type 2 diabetes mellitus. HCC, hepatocellular carcinoma; NASH, non‐alcoholic steatohepatitis. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Algorithm for screening for metabolic dysfunction‐associated fatty liver disease (MAFLD) among adults ≥ 30 years old in primary care. *Refer to relevant sections of the text, including “Lifestyle intervention is the cornerstone of management of metabolic dysfunction‐associated fatty liver disease,” “Management of metabolic risk factors to reduce cardiovascular disease risk,” and “Pharmacological treatment for metabolic dysfunction‐associated fatty liver disease” for details on the management of patients diagnosed with MAFLD. ALT, alanine aminotransferase; AST, aspartate aminotransferase; CVD, cardiovascular disease; T2DM, type 2 diabetes mellitus; US, ultrasound. [Color figure can be viewed at wileyonlinelibrary.com]
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