Incorporating a Multidisciplinary Care Approach for Metabolic Dysfunction-Associated Fatty Liver Disease Into Routine Clinical Practice

A review published in Lancet Gastroenterology and Hepatology advocated for a holistic, patient-centered care approach for metabolic dysfunction-associated fatty liver disease (MAFLD) and associated metabolic diseases, asserting that there is need for drug development and improved education for these patients.

The proportion of individuals living in the United Kingdom who have ³4 noncommunicable diseases is projected to increase from roughly 10% to 17% by 2035. This is a concerning statistic, as these noncommunicable diseases account for ~75% of deaths worldwide. As demand for patient care for MAFLD and associated metabolic diseases rises, there is a need to incorporate a holistic approach for these conditions into routine clinical practice.

Screening for MAFLD remains challenging. The criteria for MAFLD diagnosis include the presence of liver steatosis combined with overweight/obese status, type 2 diabetes, or evidence of metabolic dysfunction. Patients with MAFLD may present as asymptomatic for decades and up to 80% have serum liver enzyme concentrations within the reference range for diagnosis.

Currently, differing scientific societies have failed to come to a consensus on whether screening for MAFLD should be recommended. This is puzzling, as patients with type 2 diabetes, for example, are routinely screened for other noncommunicable diseases such as cardiovascular disease or kidney disease.

In addition, up to 95% of patients with liver disease are unaware of their status or the risks associated with MAFLD. This lack of awareness likely has harmful effects, such as nonadherence to lifestyle interventions. Clinicians should aim to engage and empower their patients with MAFLD such that they actively participate in self-care and assume responsibility and accountability for behaviors that contribute to their own health outcomes.

Caring for patients with MAFLD should include a multidisciplinary team and a care model which involves joint participation among a range of specialists. As the patient’s condition progresses, the team should cycle in different clinicians based on the needs of the patient. A similar care model has been proposed for the management of asthma, chronic obstructive pulmonary disease, and psychiatric diseases.

Patients with diabetes who receive this type of holistic care have been associated with decreased risk for cardiovascular events, stroke, and all-cause mortality. However, for MAFLD, there remains a paucity of data and additional studies on such approaches are needed.

Trials for MAFLD likely require alternative designs, such as umbrella, basket, platform, or master protocol trials. These approaches may allow for the accurate assessment of multiple interventions or outcomes which are required for robust MAFLD study.

The review authors concluded that as the global epidemic of noncommunicable metabolic diseases increases worldwide, there is need for increased awareness of the risk for MAFLD, as well as additional studies of how to most effectively treat patients who require multimorbidity therapies.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Eslam M, Ahmed A, Després J-P, et al. Incorporating fatty liver disease in multidisciplinary care and novel clinical trial designs for patients with metabolic diseases. Lancet Gastroenterol Hepatol. 2021;6(9):743-753. doi: 10.1016/S2468-1253(21)00132-1