Expert consensus on improving clinical approaches to managing liver diseases in patients with comorbidities
Skrypnyk I.M. Musabaev E.I. Nersesov A.V. Baka O.M. Golubovska O.A. Daminova L.T. Dzhumabaev M.N. Duisenova A.K. Karimov M.M. Nurillaeva N.M. Gabunia P. Raissova A.M. Sokolova L.K. Filippova O.Yu. Shagazatova B.H.
2025Publishing House Professional-Event
Family Medicine. European Practices
2025#2025Issue 321 - 26 pp.
Non-alcoholic fatty liver disease affects up to 38% of the adult population worldwide, making it the most common chronic liver disease. It is a multisystem pathology, which is caused by systemic insulin resistance and related metabolic dysfunction, and lead to steatosis, steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma, as well as to extrahepatic complications such as cardiovascular diseases, type 2 diabetes mellitus and chronic kidney disease. In 2023 the main international liver study associations have proposed to replace the term “non-alcoholic fatty liver disease” with “metabolic associated fatty liver disease” (MAFLD) to better reflect the metabolic origin of the disease. This change in terminology sparked greater scientific interest and a reassessment of clinical strategies. In March 2024, an Expert Forum on “Clinical Improvement of Approaches to Treating Liver Diseases in Comorbid Patients” brought together 16 key expert specialists of different specialities from Ukraine, Kazakhstan, Uzbekistan, Kyrgyzstan, Georgia, and Armenia. The forum focused on optimizing the treatment of MAFLD in patients with comorbid diseases. The consensus was adopted on the main recommendations: early diagnosis using modern imaging methods; lifestyle modification (diet and physical activity); pharmacotherapy; in some cases, bariatric surgery. Special attention was paid to the treatment of comorbidities, hepatogenic fatigue with ademetionine and the use of the Charlson index for survival prognosis. The document emphasizes the importance of a multidisciplinary approach, the need for further studies of pathogenesis and the development of targeted therapy. Implementation of these recommendations may improve the quality of life and long-term outcomes for patients with chronic liver disease. Conclusions. MAFLD is characterized by the accumulation of fat in the liver due to metabolic disorders. It is a common disease worldwide. Early diagnosis of the disease is vital because it can progress to severe and terminal conditions (steatohepatitis, cirrhosis, and liver cancer). Therapeutic strategies include: lifestyle changes, pharmacotherapy, and bariatric surgery. Further studies are needed to improve the understanding of the pathogenesis of MAFLD, identify biomarkers of this disease, and develop new therapeutic strategies.
chronic liver diseases , comorbid conditions , expert recommendations , fatigue , insulin resistance , metabolic syndrome , metabolic-associated fatty liver disease , multidisciplinary approach , non-alcoholic fatty liver disease
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Department of Internal Medicine No. 1 of Poltava State Medical University, Poltava, Ukraine
Scientific Research Institute of Virology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
Department of Gastroenterology of NAO “KazNMU named after S. D. Asfendiyarov”, Institute of Gastroenterology, Hepatology and Metabolism “Interna Clinic”, Medical Center of the Office of the President of the Republic of Kazakhstan, Almaty, Kazakhstan
Department of Diagnosis and Treatment of Metabolic Diseases, Gastroenterology Department of the State Scientific Institution “CIMT of NAS of Ukraine”, Kyiv, Ukraine
Department of Infectious Diseases of the Bogomolets National Medical University, Kyiv, Ukraine
Tashkent State Dental Institute, Tashkent, Uzbekistan
Department of Gastroenterology at the Mirrakhimov National Center of Cardiology and Therapy, Bishkek, Kyrgyzstan
Department of Infectious and Tropical Diseases of KazNMU named after S. D. Asfendiyarov, Almaty, Kazakhstan
Department of Gastroenterology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
Department of Internal Diseases of Family Medicine No. 1, Tashkent Medical Academy, Tashkent, Uzbekistan
Grigol Robakidze University, AIDS Center, Tbilisi, Georgia
Department of Gastroenterology of KazNMU named after S. D. Asfendiyarov, Institute of Gastroenterology, Hepatology and Metabolism Interna Clinic LLP, Almaty, Kazakhstan
Department of Diabetology, State Institution V. P. Komisarenko “Institute of Endocrinology and Metabolism of NAMS of Ukraine”, Kyiv, Ukraine
Department of Internal Medicine of Dnipro State Medical University, Dnipro, Ukraine
Department of Internal Diseases No. 2 and Endocrinology, Tashkent Medical Academy, Tashkent, Uzbekistan
Department of Internal Medicine No. 1 of Poltava State Medical University
Scientific Research Institute of Virology of the Ministry of Health of the Republic of Uzbekistan
Department of Gastroenterology of NAO “KazNMU named after S. D. Asfendiyarov”
Department of Diagnosis and Treatment of Metabolic Diseases
Department of Infectious Diseases of the Bogomolets National Medical University
Tashkent State Dental Institute
Department of Gastroenterology at the Mirrakhimov National Center of Cardiology and Therapy
Department of Infectious and Tropical Diseases of KazNMU named after S. D. Asfendiyarov
Department of Gastroenterology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation
Department of Internal Diseases of Family Medicine No. 1
Grigol Robakidze University
Department of Gastroenterology of KazNMU named after S. D. Asfendiyarov
Department of Diabetology
Department of Internal Medicine of Dnipro State Medical University
Department of Internal Diseases No. 2 and Endocrinology
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