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Research Letter

Burden of cardiovascular complications in steatotic liver disease in the United States
Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, Aijaz Ahmed
Clin Mol Hepatol 2026;32(3):e326-e330.
Published online March 25, 2026
DOI: https://doi.org/10.3350/cmh.2026.0249
  • 888 View
  • 62 Download

Letters to the Editor

Editorial

Original Article

DNMT1 facilitates the progression of metabolic dysfunction-associated steatotic liver disease by impeding transcription mediated by HNF4α and PPARα
Hyun Ahm Sohn, Hanyong Go, Tae Hyeon An, Jun Min Lee, Hee-Jin Kim, Keeok Haam, Amal Magdy, Hyo-Jung Jung, Yang-Ji Shin, Hyun Jung Lim, Yujin Jeong, Yejin Bae, Youngae Jung, Seong-Hwan Park, Kyung Chan Park, Myeong Jun Song, Eun-Wie Cho, Eun-Soo Kwon, Jeong Hwan Park, Murim Choi, Geum-Sook Hwang, Dong Hyeon Lee, Kyoung-Jin Oh, Won Kim, Mirang Kim, on behalf of the Innovative Target Exploration of NAFLD (ITEN) Consortium
Clin Mol Hepatol 2026;32(3):1201-1224.
Published online January 27, 2026
DOI: https://doi.org/10.3350/cmh.2025.1099
Background/Aims
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Aberrant DNA methylation, which is primarily maintained by DNA methyltransferase 1 (DNMT1), has been linked to metabolic dysregulation; however, its contribution to MASLD pathogenesis remains poorly defined. This study aimed to elucidate the role of DNMT1-mediated methylation in transcriptional regulation during MASLD progression and to determine whether DNMT1 inhibition can reverse disease-associated epigenetic and transcriptional alterations.
Methods
We conducted integrated analyses of the liver transcriptome (n=131) and DNA methylome (n=106) of patients with biopsy-proven MASLD. We evaluated the effect of DNMT1 inhibition with 5-aza-4′-thio-2′-deoxycytidine (Aza-TdC) on a diet-induced MASLD mouse model. Multiomics approaches, including DNA methylome profiling, lipidomics, RNA sequencing, and chromatin immunoprecipitation sequencing, were applied to elucidate the role of DNMT1-mediated DNA methylation in regulating pathogenic gene expression.
Results
DNA methylome profiling revealed increased methylation variability associated with increased DNMT1 expression in MASLD patients. DNMT1 inhibition ameliorated dysregulated lipid metabolism by reducing hepatic triacylglycerol accumulation and inflammation. Aza-TdC treatment partially reversed MASLD-related hypermethylation of hepatocyte nuclear factor 4 alpha (HNF4α)- and peroxisome proliferator-activated receptor alpha (PPARα)-regulated genes, restoring their transcriptional activity. Notably, Aza-TdC reactivated the gluconeogenic enzyme-encoding gene phosphoenolpyruvate carboxykinase 1 (PCK1), which was hypermethylated and transcriptionally repressed in MASLD. Targeted DNA methylation of the PCK1 promoter using CRISPRoff confirmed the direct epigenetic regulation of PCK1 expression.
Conclusions
Targeting DNMT1 may mitigate lipid dysregulation and inflammation by reversing hypermethylation and restoring HNF4α- and PPARα-dependent gene transcription, highlighting DNMT1 as a potential therapeutic target for MASLD.

Citations

Citations to this article as recorded by  Crossref logo
  • Sus scrofa domesticus reveals the genetic evolution of adaptive traits during early divergence
    Bohan Rong, Naiqi Niu, Wencheng Zong, Run Zhang, Xiaomei Ma, Na Zhang, Zhentong Shen, Yu Pang, Xu Lin, Di Liu, Yulong Yin, Longchao Zhang, Xiuqin Yang
    The Innovation Life.2026; : 100222.     CrossRef
  • Metabolic Reprogramming-Driven Cardiovascular Immune Damage: From Glyco-Lipotoxicity and Epigenetic Memory to Multidimensional Cross-Organ Communication Networks
    Zijin Sun, Yongchao Liu, Kai Wang, Haojia Zhang, Rui Zhou, Wei Shao
    International Journal of Molecular Sciences.2026; 27(12): 5526.     CrossRef
  • 2,571 View
  • 378 Download
  • Crossref

Letter to the Editor

Original Article

Outcomes of oral antidiabetic drugs in metabolic dysfunction-associated steatotic liver disease: a nationwide target trial emulation study
Heejoon Jang, Yeonjin Kim, Yoo Kyoung Lim, Dong Hyeon Lee, Sae Kyung Joo, Bo Kyung Koo, Gi-Ae Kim, Woojoo Lee, Stefano Romeo, Won Kim, Innovative Target Exploration of NAFLD (ITEN) consortium
Clin Mol Hepatol 2026;32(2):737-750.
Published online January 6, 2026
DOI: https://doi.org/10.3350/cmh.2025.1006
Background/Aims
Patients with concurrent type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) face elevated cardiovascular risks. However, optimal oral antidiabetic drug (OAD) selection for this population remains unclear.
Methods
Using the Korean National Health Information Database, we conducted a target trial emulation comparing cardiovascular outcomes among patients with T2DM and MASLD (defined by fatty liver index ≥30) who initiated sodium-glucose cotransporter 2 (SGLT2) inhibitors, thiazolidinediones, dipeptidyl peptidase-4 (DPP-4) inhibitors, or sulfonylureas with metformin. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke.
Results
Among 71,071 patients (331,726 person-years), SGLT2 inhibitor users experienced a significantly lower MACE risk compared to sulfonylurea users (adjusted subdistribution hazard ratio [aSHR], 0.44; 95% confidence interval [CI], 0.31–0.62). SGLT2 inhibitors also demonstrated a lower MACE risk compared to thiazolidinediones (aSHR, 0.61; 95% CI, 0.39–0.96) and DPP-4 inhibitors (aSHR, 0.59; 95% CI, 0.42–0.83). Cardiovascular mortality risk was notably reduced with SGLT2 inhibitors compared to sulfonylureas (aSHR, 0.13; 95% CI, 0.03–0.50), thiazolidinediones (aSHR, 0.19; 95% CI, 0.04–0.86), and DPP-4 inhibitors (aSHR, 0.22; 95% CI, 0.06–0.84). Mediation analysis revealed that MASLD regression accounted for 8.7% of the total cardiovascular benefit when comparing SGLT2 inhibitors to sulfonylureas.
Conclusions
In patients with concurrent T2DM and MASLD, SGLT2 inhibitors demonstrated better cardiovascular outcomes compared to other OADs. These findings suggest that SGLT2 inhibitors may be the preferred OAD choice for cardiovascular risk reduction in this high-risk population.

Citations

Citations to this article as recorded by  Crossref logo
  • Longitudinal changes in fatty liver index, genetic susceptibility, and incident atrial fibrillation
    Siyang Liu, Houde He, Hualan Chen, Hualin Duan, Ying Sun, Dan Deng, Zihao Gui, Lan Liu, Ningjian Wang, Jie Shen, Heng Wan
    Clinica Chimica Acta.2026; 589: 121028.     CrossRef
  • 4,828 View
  • 290 Download
  • 1 Web of Science
  • Crossref

Correspondence

Original Articles

Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study
Xianhua Mao, Xinrong Zhang, Rongtao Lai, Ka-Shing Cheung, Man-Fung Yuen, Ramsey Cheung, Wai-Kay Seto, Mindie H. Nguyen
Clin Mol Hepatol 2025;31(3):1084-1099.
Published online April 23, 2025
DOI: https://doi.org/10.3350/cmh.2024.1096
Background/Aims
Information about the association of glucagon-like peptide-1 receptor (GLP-1RA) with liver and non-liver complications is insufficient in patients with type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD). We conducted a target trial emulation study to evaluate whether GLP-1RA decreases the risk of liver and non-liver outcomes.
Methods
Patients with T2D and MASLD initiating GLP-1RA or dipeptidyl peptidase-4 inhibitor (DPP-4i) were included from 2013 to 2022 in Merative™ Marketscan® Research Databases. Primary outcomes included incidences of (1) hepatocellular carcinoma (HCC) and cirrhosis, and (2) cardiovascular disease (CVD), chronic kidney disease (CKD), and non-liver cancer. Inverse probability of treatment weighting was applied to balance baseline characteristics and Cox regression models were conducted to estimate hazard ratio (HR) and 95% confidence interval (CI).
Results
In the intention-to-treat design, GLP-1RA, compared with DPP-4i, had a significantly lower incidence (per 1,000 person-years) of HCC (0.8 vs. 1.7; HR 0.53, 95% CI 0.39–0.71), of cirrhosis (29.3 vs. 32.9; HR 0.91, 95% CI 0.86–0.96), of CVD (57.2 vs. 73.9; HR 0.90, 95% CI 0.86–0.95), of CKD (4.5 vs. 6.8; HR 0.73, 95% CI 0.64–0.84), and of non-liver cancer (16.9 vs. 22.9; HR 0.82, 95% CI 0.77–0.89). In the per-protocol design, significant inverse associations for these study outcomes still were observed, with HR 0.60–0.77.
Conclusions
In this emulated target trial of nationwide patients with T2D and MASLD, GLP-1RA use, when compared with DPP-4i, was associated with a significantly lower risk of liver and non-liver complications.

Citations

Citations to this article as recorded by  Crossref logo
  • Tirzepatide versus SGLT2 inhibitors for MASLD: a multi-institutional propensity score-matched cohort study
    Jheng-Yan Wu, Yu-Min Lin, Wan-Hsuan Hsu, Ting-Hui Liu, Ya-Wen Tsai, Po-Yu Huang, Min-Hsiang Chuang, Tsung Yu, Chih-Cheng Lai
    Hepatology International.2026; 20(2): 292.     CrossRef
  • Impact of newer antihyperglycemic agents on hepatic complications: A systematic review and meta-analysis of data from 5.3 million patients with type 2 diabetes mellitus
    Jiwon Yang, Yeongseok Hwang, Jin-Sung Ju, Seungbong Han, Jihyun An, Ju Hyun Shim
    Hepatology.2026;[Epub]     CrossRef
  • Association of Semaglutide Treatment With Liver Cirrhosis and Hepatocellular Carcinoma in Type 2 Diabetes: A Population‐Based Cohort Study
    Assaf Issachar, Talish Razi, Ilya Borochov, Hadar Duskin Bitan, Ronen Arbel
    Diabetes, Obesity and Metabolism.2026; 28(7): 5704.     CrossRef
  • Early cancer risk reduction after GLP-1RA use: Signal or bias?: Letter to the editor on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic l
    Shio-Shin Jean, Chih-Cheng Lai
    Clinical and Molecular Hepatology.2026; 32(2): e163.     CrossRef
  • Letter to the editor on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study”
    Chunyan Wang, Xu Han, Yinyan Li
    Clinical and Molecular Hepatology.2026; 32(2): e167.     CrossRef
  • Correspondence to letter to the editor 1 on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study
    Xianhua Mao, Mindie H. Nguyen
    Clinical and Molecular Hepatology.2026; 32(2): e231.     CrossRef
  • Correspondence to letter to the editor 2 on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study
    Xianhua Mao, Mindie H. Nguyen
    Clinical and Molecular Hepatology.2026; 32(2): e249.     CrossRef
  • Letter to the editor on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study”
    Xingyu Yao
    Clinical and Molecular Hepatology.2026; 32(2): e165.     CrossRef
  • Correspondence to editorial on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study”
    Xianhua Mao, Mindie H. Nguyen
    Clinical and Molecular Hepatology.2026; 32(2): e219.     CrossRef
  • Reply to correspondence on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target trial emulation study”
    Xingyu Yao
    Clinical and Molecular Hepatology.2026; 32(2): e267.     CrossRef
  • GLP-1RA may open a new era for MASLD treatment: Editorial on “Glucagon-like peptide 1 receptor agonist and reduced liver and non-liver complications in adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: a target tria
    Ye Feng, Chengfu Xu
    Clinical and Molecular Hepatology.2026; 32(2): 924.     CrossRef
  • Metabolic Dysfunction‐Associated Steatotic Liver Disease and Obesity: Pathogenesis, Diagnostics, Risk Stratification, and Therapeutic Approach
    Beom Kyung Kim
    The Kaohsiung Journal of Medical Sciences.2026;[Epub]     CrossRef
  • Secular Trend in Glycaemic Management in Type 2 Diabetes Patients With and Without Cirrhosis Between 2000 and 2023: A Territory‐Wide Cohort Study
    Mary Yue Wang, Sherlot Juan Song, Nana Peng, Grace Lai‐Hung Wong, Vincent Wai‐Sun Wong, Jimmy Che‐To Lai, Terry Cheuk‐Fung Yip
    Alimentary Pharmacology & Therapeutics.2026; 64(3): 356.     CrossRef
  • GLP-1 receptor agonist–SGLT-2 inhibitor combination and risk of major adverse liver and cardiovascular outcomes in adults with MASLD and type 2 diabetes
    Xianhua Mao, Hong Fan, Man-Fung Yuen, Ramsey Cheung, Wai-Kay Seto, Mindie H. Nguyen
    Hepatology.2026;[Epub]     CrossRef
  • Tumor microenvironment and metabolic reprogramming in MASLD-related hepatocellular carcinoma
    Vanilla X. Zhang, Tiffany C.-Y. Yu, Yu M. Tsui, Irene O.-L. Ng
    Trends in Molecular Medicine.2026;[Epub]     CrossRef
  • Hepatic Events Prevention by Antihyperglycemic Therapies and Intervention Comparisons in Type 2 Diabetes: The HEPATIC-T2DM Network Meta-analysis
    Pedro Robson Costa Passos, Rodrigo Motta, Valbert Oliveira Costa Filho, Mariana Macambira Noronha, Roberto Cavalcante Venâncio, Guilherme Grossi Lopes Cançado, Amanda Adler, Jeremy F. Cobbold, Jeremy W. Tomlinson
    Diabetes Care.2026; 49(6): 1144.     CrossRef
  • Predictors of Discordance Between Controlled Attenuation Parameter and Magnetic Resonance-Proton Density Fat Fraction in Hepatic Steatosis
    Dong Yun Kim, Hyung-Jin Rhee, Beom Kyung Kim
    Clinical and Translational Gastroenterology.2026;[Epub]     CrossRef
  • Glucagon-Like Peptide-1 Receptor Agonist Use and Liver-Related Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease and Type 2 Diabetes in the All of Us Research Program
    Erik Almazan, Jonggi Choi, Tushar Kamath, Vy H. Nguyen, Eric Przybyszewski, Jiunn Song, Allison Carroll, Megan Michta, Tracey G. Simon, Raymond T. Chung
    American Journal of Gastroenterology.2026;[Epub]     CrossRef
  • Association between hemoglobin glycation index and new-onset diabetes mellitus in individuals with chronic liver disease: Findings from a prospective cohort study using CHARLS data
    Yanyan Mao, Hui Kong, Li Wang, Fangyan Liao, Xiangwen Li
    Medicine.2026; 105(27): e49567.     CrossRef
  • Glucagon-like peptide-1 receptor agonists versus dipeptidyl peptidase-4 inhibitors after liver resection for hepatocellular carcinoma in patients with type 2 diabetes: a target trial emulation study
    Yan-Jun Xiang, Zong-Han Liu, Jin-Kai Feng, Ying-Yi Qin, Hong-Ming Yu, Yu-Qiang Cheng, Gang Chen, Jia-Yi Wu, Yong-Yi Zeng, Yu-Fu Tang, Jian-Hua Rao, Feng-Min Zhang, Shi-Ye Yang, Gui-Ran Wang, Lin-Sen Ye, Ren Lang, Jian-Hua Lin, Yi-Tao Zheng, Ye-Fan Mao, Ho
    Gut.2026; : gutjnl-2026-338462.     CrossRef
  • How Negative Controls Are Used in Pharmacoepidemiology: A Methodological Scoping Review of Real‐World Observational Studies of Glucagon‐Like Peptide‐1 Receptor Agonists
    Zhengxuan Li, Yinan Huang, Hua Chen, Jieni Li
    Pharmacoepidemiology and Drug Safety.2026;[Epub]     CrossRef
  • Evaluating causal protective effect of dual GLP-1R/GIPR agonists on MASLD: A Mendelian randomization and colocalization study
    Yangke Cai, Siyuan Xie, Liyi Xu, Jiamin Chen, Jianting Cai
    European Journal of Pharmacology.2025; 1005: 178088.     CrossRef
  • Impaired Thyroid Hormone Sensitivity is Associated with Increased Risk of Liver Fibrosis in Euthyroid Population: A Cross-Sectional Analysis of NHANES
    Xingyu Yao, Kaiwen Xiao, Hein Ko Oo
    Hormone and Metabolic Research.2025; 57(09): 511.     CrossRef
  • 15,219 View
  • 332 Download
  • 21 Web of Science
  • Crossref
High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction-associated steatotic liver disease
Tung-Hung Su, Sheng-Shun Yang, Mei-Hsuan Lee, Wei-Yu Kao, Shang-Chin Huang, Fen-Fang Chen, Francis SK Poon, Lung-Wen Tsai, Yi-Ting Chen, Che Lin, Weichung Wang, W Ray Kim, Jia-Horng Kao
Clin Mol Hepatol 2025;31(3):796-809.
Published online January 6, 2025
DOI: https://doi.org/10.3350/cmh.2024.0822
Background/Aims
There are no hepatocellular carcinoma (HCC) surveillance recommendations for non-viral chronic liver diseases (CLD), such as metabolic dysfunction-associated steatotic liver disease (MASLD). We explored the Steatosis-Associated Fibrosis Estimator (SAFE) score to predict HCC in MASLD and other CLD etiologies.
Methods
Patients with various CLDs were included from medical centers in Taiwan. The SAFE score, consisting of age, body mass index, diabetes, and laboratory data, was calculated at baseline, and patients were traced for new development of HCC. The predictability of the SAFE score for HCC was analyzed using the sub-distribution hazard model with adjustments for competing risks.
Results
Among 12,963 CLD patients with a median follow-up of 4 years, 258 developed HCC. The SAFE score classifies 1-, 3-, and 5-year HCC risk regardless of CLD etiologies. High (≥100) and intermediate (0–100) SAFE scores increased 11 and 2 folds HCC risks compared to low (<0) SAFE scores. Combining two lower risk tiers (SAFE<100), a high SAFE score (≥100) was associated with a 7.5-fold risk of HCC (adjusted sub-distributional hazard ratio [aSHR] 7.54; 95% confidence interval (CI) 5.38–10.60). A high SAFE score increased the risks of HCC in subgroups of viral hepatitis, non-viral hepatitis (aSHR 11.10; 95% CI 3.97–31.30) and MASLD (aSHR 4.23; 95% CI 1.43–12.50). A hospital cohort (n=8,103) and a community MASLD cohort (n=120,166) validated the high SAFE score (≥100) for HCC risk prediction.
Conclusions
The SAFE score stratifies high risks for HCC in CLD patients regardless of etiologies and helps to select at-risk candidates for HCC surveillance.

Citations

Citations to this article as recorded by  Crossref logo
  • HCC predictors in routine practice for patients with chronic liver diseases: Correspondence to editorial on “High SAFE scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction associated steatotic liver disease”
    Tung-Hung Su, Jia-Horng Kao
    Clinical and Molecular Hepatology.2026; 32(1): e52.     CrossRef
  • Can SAFE score be utilized as a universal hepatocellular carcinoma prediction score?: Editorial on “High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction-associated
    Michael Kwan-Lung Ko, Loey Lung-Yi Mak
    Clinical and Molecular Hepatology.2026; 32(1): 371.     CrossRef
  • Risk stratification for hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease: Editorial on “High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic
    Ho Soo Chun, Minjong Lee
    Clinical and Molecular Hepatology.2026; 32(1): 368.     CrossRef
  • Editorial: Residual HCC Risk After Hepatitis C Cure—Can Polygenic Risk Scores Refine Surveillance?
    Heechul Nam, Sung Won Lee
    Alimentary Pharmacology & Therapeutics.2026; 63(10): 1427.     CrossRef
  • Absence of steatosis combined with cardiometabolic risk factors confers the highest hepatocellular carcinoma risk in treated chronic hepatitis B
    Hung-Wei Wang, Hsueh-Chou Lai, Wei-Fan Hsu, Sheng-Hung Chen, Yi-Chun Kuo, Cheng-Yuan Peng
    Annals of Medicine.2026;[Epub]     CrossRef
  • Predictors of Discordance Between Controlled Attenuation Parameter and Magnetic Resonance-Proton Density Fat Fraction in Hepatic Steatosis
    Dong Yun Kim, Hyung-Jin Rhee, Beom Kyung Kim
    Clinical and Translational Gastroenterology.2026;[Epub]     CrossRef
  • 16,057 View
  • 435 Download
  • 5 Web of Science
  • Crossref

Editorial

Steatotic liver disease

Vibration-controlled transient elastography in shaping the epidemiology and management of steatotic liver disease: Editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017–2023”
Xiao-Dong Zhou, Terry Cheuk-Fung Yip, Daniel Q Huang, Mark Dhinesh Muthiah, Mazen Noureddin, Ming-Hua Zheng
Clin Mol Hepatol 2025;31(2):620-624.
Published online December 26, 2024
DOI: https://doi.org/10.3350/cmh.2024.1131

Citations

Citations to this article as recorded by  Crossref logo
  • Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes
    Na Tian, Tie Xiao, Tianyi Xia, Hai‐Yang Yuan, Michael D. Shapiro, Gregory Y. H. Lip, Cheng‐Han Fanren, Li‐You Lian, Chen‐Xiao Huang, Yi‐Xuan Wei, Giovanni Targher, Christopher D. Byrne, Cheng‐Lv Hong, Shenghong Ju, Ming‐Hua Zheng
    Alimentary Pharmacology & Therapeutics.2026; 63(1): 70.     CrossRef
  • Editorial: Does Metabolic Dysfunction‐Associated Steatotic Liver Disease With Advanced Fibrosis Also Equate to Risk of Advanced Coronary Artery Disease? Authors' Reply
    Xiao‐Dong Zhou, Yusuf Yilmaz, Ming‐Hua Zheng
    Alimentary Pharmacology & Therapeutics.2026; 63(1): 155.     CrossRef
  • Long-Term Glycemic Control and the Risk of Liver Stiffness Progression and Liver-Related Events in MASLD
    Xiao-Dong Zhou, Qin-Fen Chen, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah-Kheong Chan, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen,
    Clinical Gastroenterology and Hepatology.2026; 24(5): 1332.     CrossRef
  • Progression of Liver Fibrosis and Liver-related Event Risk in Metabolic Dysfunction-associated Steatotic Liver Disease at High Cardiovascular Risk
    Xiao-Dong Zhou, Qin-Fen Chen, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah-Kheong Chan, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen,
    Clinical Gastroenterology and Hepatology.2026;[Epub]     CrossRef
  • MASLD as a systemic metabolic disease: expanding the scope of cardiovascular-kidney-metabolic (CKM) syndrome
    Xiao-Dong Zhou, Qiong-Yue Fan, Giovanni Targher, Christopher D. Byrne, Qin-Fen Chen, Michael D. Shapiro, Yuxing Dong, Ki-Chul Sung, Gregory Y. H. Lip, Jeffrey V. Lazarus, Ming-Hua Zheng
    Science China Life Sciences.2026; 69(6): 1950.     CrossRef
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    Xiao-Dong Zhou, Mark D. Muthiah, Ming-Hua Zheng
    JHEP Reports.2025; : 101372.     CrossRef
  • Addressing the burden of steatotic liver disease: The role of transient elastography: Correspondence to editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017-2023”
    Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, George Cholankeril, Rohit Loomba, Aijaz Ahmed
    Clinical and Molecular Hepatology.2025; 31(2): e180.     CrossRef
  • The association of advanced lung cancer inflammation index with non-alcoholic fatty liver disease in NHANES 2017–2020
    Lin Cheng, Shumeng Li, Hui Li, Jiafeng You, Mingwei Yu, Guowang Yang
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • 8,772 View
  • 77 Download
  • 7 Web of Science
  • Crossref

Reviews

Steatotic liver disease

Microbiome-centered therapies for the management of metabolic dysfunction-associated steatotic liver disease
Huma Saeed, Luis Antonio Díaz, Antonio Gil-Gómez, Jeremy Burton, Jasmohan S. Bajaj, Manuel Romero-Gomez, Marco Arrese, Juan Pablo Arab, Mohammad Qasim Khan
Clin Mol Hepatol 2025;31(Suppl):S94-S111.
Published online November 28, 2024
DOI: https://doi.org/10.3350/cmh.2024.0811
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant global health issue, affecting over 30% of the population worldwide due to the rising prevalence of metabolic risk factors such as obesity and type 2 diabetes mellitus. This spectrum of liver disease ranges from isolated steatosis to more severe forms such as steatohepatitis, fibrosis, and cirrhosis. Recent studies highlight the role of gut microbiota in MASLD pathogenesis, showing that dysbiosis significantly impacts metabolic health and the progression of liver disease. This review critically evaluates current microbiome-centered therapies in MASLD management, including prebiotics, probiotics, synbiotics, fecal microbiota transplantation, and emerging therapies such as engineered bacteria and bacteriophage therapy. We explore the scientific rationale, clinical evidence, and potential mechanisms by which these interventions influence MASLD. The gut-liver axis is crucial in MASLD, with notable changes in microbiome composition linked to disease progression. For instance, specific microbial profiles and reduced alpha diversity are associated with MASLD severity. Therapeutic strategies targeting the microbiome could modulate disease progression by improving gut permeability, reducing endotoxin-producing bacteria, and altering bile acid metabolism. Although promising, these therapies require further research to fully understand their mechanisms and optimize their efficacy. This review integrates findings from clinical trials and experimental studies, providing a comprehensive overview of microbiome-centered therapies’ potential in managing MASLD. Future research should focus on personalized strategies, utilizing microbiome features, blood metabolites, and customized dietary interventions to enhance the effectiveness of these therapies.

Citations

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  • Probiotic-Derived Strain-Specific Metabolites Ameliorate Metabolic Dysfunction–Associated Steatotic Liver Disease through Modulation of the Gut-Liver Axis
    Sang Jun Yoon, Jieun Choi, Sung-Min Won, Jeong Seok Yu, Hee Young Kim, Hyun Chae Joung, In Gyu Park, Jung A Eom, Sang Hak Han, Do Yup Lee, Ki Tae Suk
    Probiotics and Antimicrobial Proteins.2026; 18(3): 4353.     CrossRef
  • Sarcopenia and MASLD: novel insights and the future
    Chang-Hai Liu, Qing-Min Zeng, Won Kim, Seung Up Kim, Zobair M. Younossi, Giovanni Targher, Christopher D. Byrne, Christos S. Mantzoros, Phunchai Charatcharoenwitthaya, Isabelle Anne Leclercq, Manuel Romero-Gómez, Hong Tang, Ming-Hua Zheng
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    Nila Ganamurali, Sarvesh Sabarathinam
    Prostaglandins & Other Lipid Mediators.2026; 182: 107055.     CrossRef
  • Guideline comparison for fatty liver disease: European (EASL-EASD-EASO) and Asian (APASL) perspectives
    Ludovico Abenavoli
    Expert Review of Gastroenterology & Hepatology.2026; 20(1): 5.     CrossRef
  • The Metabolic Dysfunction–Associated Steatotic Liver Disease–CKD Axis: Intersecting Pathways and Opportunities for Early Intervention
    Sriram Sriperumbuduri, Prathab Balaji Saravanan, Gaurav Gupta, Arun J. Sanyal
    Kidney International Reports.2026; 11(4): 103757.     CrossRef
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Viral hepatitis

Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
Saisai Zhang, Lung-Yi Mak, Man-Fung Yuen, Wai-Kay Seto
Clin Mol Hepatol 2025;31(Suppl):S182-S195.
Published online November 21, 2024
DOI: https://doi.org/10.3350/cmh.2024.0837
Chronic hepatitis B (CHB) poses a major global public health challenge and is a leading cause of cirrhosis and liver cancer. Hepatic steatosis is common in individuals with CHB compared to the non-CHB population and is particularly prevalent in hepatitis B virus (HBV)-endemic regions, affecting about one-third of CHB patients. The interaction between hepatic steatosis and CHB-related disease progression is complex and still under debate. Evidence demonstrates that co-existing steatosis may worsen liver fibrosis while paradoxically increasing the likelihood of achieving better HBV control. In particular, despite the association of steatotic liver disease (SLD) with lower HBV viral loads and higher rates of HBsAg seroclearance, the coexistence of CHB and SLD can potentially accelerate liver disease progression. Factors such as fat deposition, lipotoxicity, oxidative stress, and chronic inflammation in SLD may foster a pro-fibrotic and pro-carcinogenic environment, accelerating the disease progression. Additionally, loss of global DNA methylation, changes in the immune microenvironment, and genetic susceptibility further contribute to the development of CHB-related cirrhosis and hepatocellular carcinoma (HCC). This review examines the mechanisms driving liver disease progression and the heightened risk of cirrhosis and HCC in patients with concurrent CHB and steatotic liver disease, underscoring the importance of prioritizing antiviral therapy for CHB in addition to addressing SLD.

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Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

Citations

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Letter to the Editor

Steatotic liver disease

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Original Article

Steatotic liver disease

Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis
Young Eun Chon, Young-Joo Jin, Jihyun An, Hee Yeon Kim, Miyoung Choi, Dae Won Jun, Mi Na Kim, Ji Won Han, Han Ah Lee, Jung Hwan Yu, Seung Up Kim
Clin Mol Hepatol 2024;30(Suppl):S117-S133.
Published online August 21, 2024
DOI: https://doi.org/10.3350/cmh.2024.0392
Background/aims
Opinions differ regarding vibration-controlled transient elastography and magnetic resonance elastography (VCTE/MRE) cut-offs for diagnosing advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the diagnostic performance and optimal cut-off values of VCTE and MRE for diagnosing AF.
Methods
Literature databases, including Medline, EMBASE, Cochrane Library, and KoreaMed, were used to identify relevant studies published up to June 13, 2023. We selected studies evaluating VCTE and MRE regarding the degree of liver fibrosis using liver biopsy as the reference. The sensitivity, specificity, and area under receiver operating characteristics curves (AUCs) of the pooled data for VCTE and MRE for each fibrosis stage and optimal cut-offs for AF were investigated.
Results
A total of 19,199 patients from 63 studies using VCTE showed diagnostic AUC of 0.83 (95% confidence interval: 0.80–0.86), 0.83 (0.80–0.86), 0.87 (0.84–0.90), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. Similarly, 1,484 patients from 14 studies using MRE showed diagnostic AUC of 0.89 (0.86–0.92), 0.92 (0.89–0.94), 0.89 (0.86–0.92), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. The diagnostic AUC for AF using VCTE was highest at 0.90 with a cut-off of 7.1–7.9 kPa, and that of MRE was highest at 0.94 with a cut-off of 3.62–3.8 kPa.
Conclusions
VCTE (7.1–7.9 kPa) and MRE (3.62–3.8 kPa) with the suggested cut-offs showed favorable accuracy for diagnosing AF in patients with NAFLD. This result will serve as a basis for clinical guidelines for non-invasive tests and differential diagnosis of AF.

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Steatotic liver disease

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Editorial

Letters to the Editor

Steatotic liver disease

Changing from NAFLD to MASLD: Cumulative incidence of gallstones between patients with NAFLD and those with MASLD in Asia
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Clin Mol Hepatol 2024;30(4):959-961.
Published online May 10, 2024
DOI: https://doi.org/10.3350/cmh.2024.0233

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Clin Mol Hepatol 2024;30(2):266-268.
Published online January 30, 2024
DOI: https://doi.org/10.3350/cmh.2024.0028

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Correspondence

Artificial intelligence, epidemiology, methodology, or others

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Letter to the Editor

Artificial intelligence, epidemiology, methodology, or others

Letter 2 regarding “Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma”
Yiwen Zhang, Liwei Wu, Zepeng Mu, Linlin Ren, Ying Chen, Hanyun Liu, Lili Xu, Yangang Wang, Yaxing Wang, Susan Cheng, Yih Chung Tham, Bin Sheng, Tien Yin Wong, Hongwei Ji
Clin Mol Hepatol 2024;30(1):113-117.
Published online November 10, 2023
DOI: https://doi.org/10.3350/cmh.2023.0440

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Snapshot

Steatotic liver disease

Recent updates on pharmacologic therapy in non-alcoholic fatty liver disease
Young Chang, Soung Won Jeong, Jae Young Jang
Clin Mol Hepatol 2024;30(1):129-133.
Published online October 13, 2023
DOI: https://doi.org/10.3350/cmh.2023.0356

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Correspondence

Steatotic liver disease

Correspondence on Letter regarding “Risk factors in nonalcoholic fatty liver disease”
Eileen L. Yoon, Dae Won Jun
Clin Mol Hepatol 2023;29(4):1050-1051.
Published online August 29, 2023
DOI: https://doi.org/10.3350/cmh.2023.0310

Citations

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  • Reply to correspondence on “Prognosis of biopsy-confirmed metabolic dysfunction-associated steatotic liver disease: A sub-analysis of the CLIONE study”
    Eileen Laurel Yoon, Dae Won Jun
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  • Crossref

Special Review

Steatotic liver disease

Critical appraisal of metabolic dysfunction-associated steatotic liver disease: Implication of Janus-faced modernity
Gi-Ae Kim, Joon Ho Moon, Won Kim
Clin Mol Hepatol 2023;29(4):831-843.
Published online August 25, 2023
DOI: https://doi.org/10.3350/cmh.2023.0277
The existing term non-alcoholic fatty liver disease (NAFLD) has raised substantial concerns due to its inherent disadvantages of using exclusionary diagnostic criteria and the stigmatizing word ‘fatty.’ Three pan-national liver associations set out to explore a new nomenclature to replace both NAFLD and its suggested alternative, metabolic (dysfunction)-associated fatty liver disease (MAFLD). They surveyed if a change in nomenclature and/or definition is favored and which nomenclature best communicates disease characteristics and increases awareness. In lieu of NAFLD/MAFLD, metabolic dysfunction-associated steatotic liver disease (MASLD) has been chosen, and an umbrella term, steatotic liver disease (SLD), encompassing the whole spectrum of liver disease, has been proposed. It has been suggested that cardiometabolic risk factors should be considered when categorizing SLD patients. Furthermore, a new subcategory, MASLD with increased alcohol intake (MetALD), casts light on a neglected group of patients with moderate or more alcohol consumption. The importance of metabolic dysfunction was acknowledged in this new nomenclature, but the precise contribution of metabolic dysfunction and alcohol consumption to the development and progression of SLD remains unclear. Herein, we review hepatologists’ and endocrinologists’ perspectives on the new nomenclature, along with its possible impact on clinical practice. Although it is premature to predict the settlement of the new nomenclature, this review may help build more evidence for a soft landing of it in the future.

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Original Article

Steatotic liver disease

Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity
Hong-Kyu Kim, Sung-Jin Bae, Min Jung Lee, Eun Hee Kim, Hana Park, Hwi Seung Kim, Yun Kyung Cho, Chang Hee Jung, Woo Je Lee, Jaewon Choe
Clin Mol Hepatol 2023;29(4):987-1001.
Published online July 5, 2023
DOI: https://doi.org/10.3350/cmh.2023.0035
Background/Aims
To investigate whether non-alcoholic fatty liver disease (NAFLD) in individuals without generalized obesity is associated with visceral fat obesity (VFO), sarcopenia, and/or myosteatosis.
Methods
This cross-sectional analysis included 14,400 individuals (7,470 men) who underwent abdominal computed tomography scans during routine health examinations. The total abdominal muscle area (TAMA) and skeletal muscle area (SMA) at the 3rd lumbar vertebral level were measured. The SMA was divided into the normal attenuation muscle area (NAMA) and low attenuation muscle area, and the NAMA/TAMA index was calculated. VFO was defined by visceral to subcutaneous fat ratio, sarcopenia by body mass index-adjusted SMA, and myosteatosis by the NAMA/TAMA index. NAFLD was diagnosed with ultrasonography.
Results
Of the 14,400 individuals, 4,748 (33.0%) had NAFLD, and the prevalence of NAFLD among non-obese individuals was 21.4%. In regression analysis, both sarcopenia (men: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19–1.67, P<0.001; women: OR=1.59, 95% CI 1.40–1.90, P<0.001) and myosteatosis (men: OR=1.24, 95% CI 1.02–1.50, P=0,028; women: OR=1.23, 95% CI 1.04–1.46, P=0.017) were significantly associated with non-obese NAFLD after considering for VFO and other various risk factors, whereas VFO (men: OR=3.97, 95% CI 3.43–4.59 [adjusted for sarcopenia], OR 3.98, 95% CI 3.44–4.60 [adjusted for myosteatosis]; women: OR=5.42, 95% CI 4.53–6.42 [adjusted for sarcopenia], OR=5.33, 95% CI 4.51–6.31 [adjusted for myosteatosis]; all P<0.001) was strongly associated with non-obese NAFLD after adjustment with various known risk factors.
Conclusions
In addition to VFO, sarcopenia and/or myosteatosis were significantly associated with non-obese NAFLD.

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Correspondence

Steatotic liver disease

Correspondence on Letter regarding “Non-alcoholic fatty liver disease: Definition and subtypes”
Seul Ki Han, Soon Koo Baik, Moon Young Kim
Clin Mol Hepatol 2023;29(3):817-819.
Published online May 17, 2023
DOI: https://doi.org/10.3350/cmh.2023.0155

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Letter to the Editor

Steatotic liver disease

Letter regarding “Non-alcoholic fatty liver disease: Definition and subtypes”
Seogsong Jeong, Yohwan Lim, Su Kyoung Lee, Hyun Wook Han
Clin Mol Hepatol 2023;29(3):810-811.
Published online May 8, 2023
DOI: https://doi.org/10.3350/cmh.2023.0129

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Original Article

Viral hepatitis

Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis
Yu Jun Wong, Vy H. Nguyen, Hwai-I Yang, Jie Li, Michael Huan Le, Wan-Jung Wu, Nicole Xinrong Han, Khi Yung Fong, Elizebeth Chen, Connie Wong, Fajuan Rui, Xiaoming Xu, Qi Xue, Xin Yu Hu, Wei Qiang Leow, George Boon-Bee Goh, Ramsey Cheung, Grace Wong, Vincent Wai-Sun Wong, Ming-Whei Yu, Mindie H. Nguyen
Clin Mol Hepatol 2023;29(3):705-720.
Published online May 8, 2023
DOI: https://doi.org/10.3350/cmh.2023.0004
Background/Aims
Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients.
Methods
We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random- effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment.
Results
We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88–95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27–0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all p≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, p<0.0001).
Conclusions
IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.

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Editorials

Steatotic liver disease

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    Eileen L. Yoon, Dae Won Jun
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  • Correspondence on Letter regarding “Waiting for the changes after the adoption of steatotic liver disease”
    Eileen L. Yoon, Dae Won Jun
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  • 12 Web of Science
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Steatotic liver disease

Implications of comorbidities in nonalcoholic fatty liver disease
Sherlot Juan Song, Vincent Wai-Sun Wong
Clin Mol Hepatol 2023;29(2):384-389.
Published online March 14, 2023
DOI: https://doi.org/10.3350/cmh.2023.0066

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Steatotic liver disease

Citations

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  • Serum vitamin D and lean non-alcoholic fatty liver disease: a nonlinear ‘L-shaped’ association in a national cross-sectional study
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Steatotic liver disease

How to optimize the outcome of liver transplantation for non-alcoholic fatty liver disease
Byeong Geun Song, Dong Hyun Sinn
Clin Mol Hepatol 2023;29(2):411-413.
Published online March 6, 2023
DOI: https://doi.org/10.3350/cmh.2023.0058

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  • Microemulsion co-delivering curcumin and DHA-rich algal oil alleviates nonalcoholic fatty liver disease
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    Soon Kyu Lee
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Steatotic liver disease

Citations

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  • Exercise as a Metabolic Therapy for MASLD: Beyond Weight Loss Toward Sustainable Exercise Strategies
    Hee-Tae Roh, Ju-Yong Bae
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  • Crossref

Reviews

Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives
Shang-Chin Huang, Chun-Jen Liu
Clin Mol Hepatol 2023;29(2):320-331.
Published online February 1, 2023
DOI: https://doi.org/10.3350/cmh.2022.0422
The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) has increased among the general population and chronic hepatitis B (CHB) patients worldwide. Although fatty liver disease is a well-known risk factor for adverse liver outcomes like cirrhosis and hepatocellular carcinoma, its interactions with the hepatitis B virus (HBV) and clinical impacts seem complex. The presence of hepatic steatosis may suppress HBV viral activity, potentially leading to attenuated liver injury. In contrast, the associated co-morbidities like diabetes mellitus or obesity may increase the risk of developing adverse liver outcomes. These findings implicate that components of MAFLD may have diverse effects on the clinical manifestations of CHB. To this end, a clinical strategy is proposed for managing patients with concurrent CHB and MAFLD. This review article discusses the updated evidence regarding disease prevalence, interactions between steatosis and HBV, clinical impacts, and management strategies, aiming at optimizing holistic health care in the CHB population.

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Steatotic liver disease

Non-alcoholic fatty liver disease: Definition and subtypes
Seul Ki Han, Soon Koo Baik, Moon Young Kim
Clin Mol Hepatol 2023;29(suppl):S5-S16.
Published online December 28, 2022
DOI: https://doi.org/10.3350/cmh.2022.0424
Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide, with a global prevalence of approximately 30%. However, the prevalence of NAFLD has been variously reported depending on the comorbidities. The rising prevalence of obesity in both the adult and pediatric populations is projected to consequently continue increasing NAFLD prevalence. It is a major cause of chronic liver disease worldwide, including cirrhosis and hepatocellular carcinoma (HCC). NAFLD has a variety of clinical phenotypes and heterogeneity due to the complexity of pathogenesis and clinical conditions of its occurrence, resulting in various clinical prognoses. In this article, we briefly described the basic definition of NAFLD and classified the subtypes based on current knowledge in this field.

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Original Article

Steatotic liver disease

The independent effect of exercise on biopsy-proven non-alcoholic fatty liver disease: A systematic review
George Chen, Bubu Banini, Albert Do, Joseph K. Lim
Clin Mol Hepatol 2023;29(Suppl):S319-S332.
Published online December 14, 2022
DOI: https://doi.org/10.3350/cmh.2022.0366
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Although previous studies have demonstrated that exercise independently reduces hepatic steatosis measured by imaging modalities in NAFLD, the effect of exercise on histological endpoints remains unclear. We aimed to conduct a systematic review of the independent effect of exercise on hepatic steatosis, steatohepatitis, and liver fibrosis as measured by histological assessment or non-invasive tests (NITs) in biopsy-proven NAFLD. A systematic literature search of PubMed, Embase, and Web of Science databases was performed using keywords related to exercise, NAFLD, and biopsy. Articles were selected based on the following inclusion criteria: (1) involved human subjects with biopsy-proven NAFLD, (2) analyzed the independent effect of exercise, (3) assessed changes in hepatic steatosis, steatohepatitis, or liver fibrosis via either histological evaluation or NITs, and (4) were original research studies. We identified a total of six studies that analyzed the independent effect of exercise on histological endpoints in biopsy-proven NAFLD. Two randomized controlled trials (RCTs) did not detect significant histological improvement following exercise interventions, while other non-randomized interventional studies showed that exercise reduces hepatocyte ballooning and liver fibrosis. In addition, five studies assessed NIT outcomes, collectively demonstrating that exercise improves hepatic steatosis measured by magnetic resonance imaging-based techniques but not serum biomarkers for steatohepatitis and liver fibrosis. Additional large RCTs and meta-analyses are warranted to investigate the independent effect of exercise on histological and clinical outcome endpoints in NAFLD.

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Reviews

Steatotic liver disease

Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: present and future
Asako Nogami, Masato Yoneda, Michihiro Iwaki, Takashi Kobayashi, Yasushi Honda, Yuji Ogawa, Kento Imajo, Satoru Saito, Atsushi Nakajima
Clin Mol Hepatol 2023;29(Suppl):S123-S135.
Published online December 12, 2022
DOI: https://doi.org/10.3350/cmh.2022.0357
Non-alcoholic fatty liver disease is currently the most common chronic liver disease, affecting up to 25% of the global population. Simple fatty liver, in which fat is deposited in the liver without fibrosis, has been regarded as a benign disease in the past, but it is now known to be prognostic. In the future, more emphasis should be placed on the quantification of liver fat. Traditionally, fatty liver has been assessed by histological evaluation, which requires an invasive examination; however, technological innovations have made it possible to evaluate fatty liver by non-invasive imaging methods, such as ultrasonography, computed tomography, and magnetic resonance imaging. In addition, quantitative as well as qualitative measurements for the detection of fatty liver have become available. In this review, we summarize the currently used qualitative evaluations of fatty liver and discuss quantitative evaluations that are expected to further develop in the future.

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Steatotic liver disease

Identification of high-risk subjects in nonalcoholic fatty liver disease
Christiane Stern, Laurent Castera
Clin Mol Hepatol 2023;29(Suppl):S196-S206.
Published online December 5, 2022
DOI: https://doi.org/10.3350/cmh.2022.0431
Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease worldwide, and its burden is expected to increase due to the growing epidemic of obesity and diabetes. The key challenge among NAFLD patients is to identify those with advanced fibrosis (F3F4), who are at high risk of developing complications and will benefit from specialized management and treatment with new pharmacotherapies when they are approved. Liver biopsy appears unrealistic and unsuitable in practice, given the large number of high-risk patients and its well-known limitations. Non-invasive sequential algorithms using fibrosis-4 index as first-line test, followed by vibration-controlled transient elastography or patented blood test, are the best strategy for case finding of high-risk subjects. In fact, they are now recommended by several international guidelines, and should be used and disseminated to increase awareness among physicians beyond liver clinics where most NAFLD patients are seen.

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Letter to the Editor

Steatotic liver disease

Correspondence on Letter regarding “The usefulness of metabolic score for insulin resistance for the prediction of incident non-alcoholic fatty liver disease in Korean adults”
Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
Clin Mol Hepatol 2023;29(1):179-181.
Published online November 22, 2022
DOI: https://doi.org/10.3350/cmh.2022.0409

Citations

Citations to this article as recorded by  Crossref logo
  • Impact of smoking cessation on non-alcoholic fatty liver disease prevalence: a systematic review and meta-analysis
    Shengan Zhang, Zhidong Liu, Qinghua Yang, Zichun Hu, Wenjun Zhou, Guang Ji, Yanqi Dang
    BMJ Open.2023; 13(12): e074216.     CrossRef
  • 6,402 View
  • 54 Download
  • 1 Web of Science
  • Crossref

Reviews

Steatotic liver disease

Causes and risk profiles of mortality among individuals with nonalcoholic fatty liver disease
Peter Konyn, Aijaz Ahmed, Donghee Kim
Clin Mol Hepatol 2023;29(Suppl):S43-S57.
Published online November 22, 2022
DOI: https://doi.org/10.3350/cmh.2022.0351
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and worldwide. Though nonalcoholic fatty liver per se may not be independently associated with an increased risk for all-cause mortality, it is associated with a number of harmful metabolic risk factors, such as type 2 diabetes mellitus, hyperlipidemia, obesity, a sedentary lifestyle, and an unhealthy diet. The fibrosis stage is a predictor of all-cause mortality in NAFLD. Mortality in individuals with NAFLD has been steadily increasing, and the most common cause-specific mortality for NAFLD is cardiovascular disease, followed by extra-hepatic cancer, liver-related mortality, and diabetes. High-risk profiles for mortality in NAFLD include PNPLA3 I148M polymorphism, low thyroid function and hypothyroidism, and sarcopenia. Achieving weight loss through adherence to a high-quality diet and sufficient physical activity is the most important predictor of improvement in NAFLD severity and the benefit of survival. Given the increasing health burden of NAFLD, future studies with more long-term mortality data may demonstrate an independent association between NAFLD and mortality.

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Steatotic liver disease

Non-alcoholic fatty liver disease: the pathologist’s perspective
Wei-Qiang Leow, Anthony Wing-Hung Chan, Paulo Giovanni L. Mendoza, Regina Lo, Kihan Yap, Haeryoung Kim
Clin Mol Hepatol 2023;29(Suppl):S302-S318.
Published online November 15, 2022
DOI: https://doi.org/10.3350/cmh.2022.0329
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic steatohepatitis, to cirrhosis. While histopathological evaluation of liver biopsies plays a central role in the diagnosis of NAFLD, limitations such as the problem of interobserver variability still exist and active research is underway to improve the diagnostic utility of liver biopsies. In this article, we provide a comprehensive overview of the histopathological features of NAFLD, the current grading and staging systems, and discuss the present and future roles of liver biopsies in the diagnosis and prognostication of NAFLD.

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Letters to the Editor

Steatotic liver disease

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence on Letter regarding “The usefulness of metabolic score for insulin resistance for the prediction of incident non-alcoholic fatty liver disease in Korean adults”
    Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
    Clinical and Molecular Hepatology.2023; 29(1): 179.     CrossRef
  • 6,773 View
  • 61 Download
  • 1 Web of Science
  • Crossref

Steatotic liver disease

  • 6,332 View
  • 77 Download

COVID-19

Correspondence on Letter regarding “COVID-19 vaccine immunogenicity among chronic liver disease patients and liver transplant recipients: A meta-analysis”
Ka Shing Cheung, Chiu Hang Mok, Wai Kay Seto, Man Fung Yuen
Clin Mol Hepatol 2023;29(1):176-178.
Published online November 10, 2022
DOI: https://doi.org/10.3350/cmh.2022.0377
  • 7,725 View
  • 59 Download

Correspondence

Steatotic liver disease

Correspondence on Editorial regarding “Screening and prediction of nonalcoholic fatty liver disease using a peripheral insulin resistance index: Potential benefits and limitations”
Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
Clin Mol Hepatol 2023;29(1):185-187.
Published online November 10, 2022
DOI: https://doi.org/10.3350/cmh.2022.0375
  • 6,446 View
  • 56 Download
Letter to the Editor

Steatotic liver disease

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  • Correspondence on Letter regarding “Auranofin attenuates hepatic steatosis and fibrosis in nonalcoholic fatty liver disease via NRF2 and NF-κB signaling pathways”
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    Clinical and Molecular Hepatology.2023; 29(1): 171.     CrossRef
  • 7,162 View
  • 71 Download
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