Editor's note
Metabolism-associated fatty liver disease (MAFLD) is a chronic progressive liver disease closely related to metabolic syndrome, with the epidemic of obesity and diabetes, the prevalence of MAFLD in the world and continent is increasing, and the patient population is getting younger and younger, which has become an increasingly serious public health problem. MAFLD can progress to metabolism-associated steatohepatitis (MASH), which can lead to liver fibrosis, cirrhosis, or liver cancer. Recently, at the launch meeting of the NASH Research Consortium of the sub-forum of the Beijing "Friendship" Integrated Traditional Chinese and Western Medicine Innovation Forum, "Progress in the Diagnosis and Treatment of Metabolism-related Fatty Liver Disease with Integrated Traditional Chinese and Western Medicine", Liver Disease International interviewed Professor Jia Jidong of Beijing Friendship Hospital and Professor Xu Chunjun of Beijing Hospital of Traditional Chinese Medicine on the treatment of MAFLD and other related issues. This magazine has compiled the content of the interview into an article for the benefit of readers.
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International Liver Disease
Professor Jia, as a consultant of the NASH Specialized Disease Research Consortium, could you please introduce the original intention of establishing the NASH Specialized Disease Research Consortium? What kind of help or impact will the NASH Consortium bring to the prevention and treatment of MAFLD?
Professor Jia Jidong: In the past, we called it non-alcoholic fatty liver disease, abbreviated as NAFLD; Now we call it metabolically associated fatty liver disease, abbreviated as MAFLD or MASLD, and is currently in the process of popularizing the professional name. With the improvement of people's living standards and lifestyle changes, MAFLD is becoming more and more important. In the past, we focused on viral hepatitis, but now with the advancement of hepatitis B prevention and control, the number of new cases of hepatitis B has decreased dramatically. In the future, the burden of liver disease will gradually shift to alcohol-related fatty liver disease and MAFLD, which we are discussing today. Therefore, it is time to focus on this issue.
As a clinical research consortium in the Beijing area, we not only play synergies in medical activities, but also want to make a difference in clinical research. Beijing Friendship Hospital is also the lead unit of this project and has applied for relevant projects from the Beijing Municipal Health Commission and the Beijing Hospital Authority. We hope to coordinate all parties to make greater contributions to the diagnosis, treatment and clinical research of MAFLD.
Our main task is to carry out top-level design and overall planning, and at the same time, combined with the actual situation of each hospital, although we may choose different topics or projects, but one thing is common, that is, we all need to establish our own long-term follow-up cohort on the basis of standardized clinical practice. This is a long-term and fundamental work, and only by establishing a good long-term cohort and a complete database can we carry out more in-depth and high-quality scientific research. The results and clinical evidence produced by these scientific research efforts will further guide clinical practice. This is also one of the original intentions of our establishment of the research consortium.
International Liver Disease
Prof. Xu, as an advisor to the NASH Consortium, could you please share some of the important projects or studies you have been involved in in the NASH Consortium? How do you think the NASH Consortium should play a further role in the future to drive innovation in diagnosis and treatment technology and improve patient management?
Prof. Chunjun Xu: In the NASH Specialized Disease Research Consortium, the research of each unit has its own characteristics, some focus on clinical research and drug development, some focus on drug intervention mechanisms, some cooperate with grassroots communities to carry out homologous co-management projects, and some carry out research related to childhood obesity. For example, I participated in a study in collaboration with Dongfang Hospital and Guang'anmen Hospital to explore the application of spleen and liver soothing method in the treatment of MAFLD, and achieved positive results, and subsequently completed the transformation of results.
If the research consortium wants to innovate in technology and management in the future, I think it can start from the following three aspects:
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First, based on previous prospective and retrospective data, develop implementable treatment and intervention plans, and establish standardized guidelines. These protocols need to be optimized as real-world studies and subsequent prospective studies progress.
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Second, set up a professional research team and build a management model for patients with chronic diseases such as MAFLD. Only with a professional team and an effective management model can the standards be implemented into practical work and a more optimized treatment plan can be formed through long-term research.
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Third, through multi-party coordination, a consensus should be formed to build a common diagnosis and treatment and management plan. After the success of such a model, it can be promoted not only in Beijing, but also nationwide, with a larger sample size and greater influence.
The establishment of the research consortium is very timely, and through multi-party cooperation and joint efforts, a more unified and effective diagnosis and treatment standard and management model can be formed, and the diagnosis and treatment technology innovation and patient management improvement of MAFLD and other chronic diseases can be promoted.
International Liver Disease
Prof. Jia, how do you think MAFLD should be prevented and treated?
Prof. Jia Jidong: MAFLD is mainly affected by lifestyle, such as high calorie, high sugar, especially high cholesterol and high fructose diet, which is one of the important factors. In addition, lack of exercise and physical activity is also an important factor. Of course, genetic factors also play a role in the occurrence and development of the disease, such as the susceptibility of different individuals to fatty liver is significantly different, some patients only develop fatty liver when they are overweight, some patients are slightly overweight and develop fatty liver, and even more are not overweight but have fatty liver. Therefore, treatment and prevention strategies for MAFLD vary from person to person.
For cases where lifestyle-induced obesity is more pronounced, we focus on lifestyle interventions, such as diet control, increased exercise, and weight loss, which usually produce satisfactory results. For those who are not overweight or even thin but can still develop fatty liver, they may have a certain genetic background and genetic predisposition. In this case, while lifestyle modifications can help, we need to seek pharmacological intervention.
At present, the means of drug intervention are limited, but some drugs have been found to have good efficacy in MAFLD, such as glucagon-like polypeptide-1 (GLP-1) receptor agonists, GLP-1/glucose-dependent insulinotropic polypeptide (GIP) dual receptor agonists. Another broad class of effective drugs are thyroid hormone β receptor agonists. In the future, we expect more drugs to come out gradually.
Therefore, the prevention of MAFLD is mainly based on lifestyle interventions, focusing on diet control and increased exercise. In terms of treatment, we pay more attention to the links related to metabolism. These drugs mainly reduce the accumulation of liver fat by interfering with metabolism, which in turn reduces the risk of liver inflammation, necrosis, and liver fibrosis.
To sum up, in terms of prevention, we emphasize life intervention-oriented; In terms of treatment, lifestyle interventions are still the foundation, but at the same time, we will also introduce some new specific drugs, including traditional Chinese medicine, which can also play a significant role in this regard. In addition, acupuncture and other non-pharmacological therapies also play an important role in the treatment of MAFLD.
International Liver Disease
Professor Xu, you have extensive clinical experience in the treatment of liver diseases with traditional Chinese medicine. From the perspective of traditional Chinese medicine, how do you view MAFLD? How does TCM treat it?
Prof. Xu Chunjun: Traditional Chinese medicine and modern medicine have similarities and differences in their view of diseases. As far as the modern medical term "metabolism-related fatty liver disease" is concerned, there is no such word in traditional Chinese medicine theory, but it can be understood from the perspective of "fatness" or "fatness".
From the perspective of TCM diagnosis, the external manifestations and signs or symptoms are only the appearance, and in-depth exploration shows that the treatment of TCM focuses more on the cause and pathogenesis of the disease. Many studies have shown that the etiology and pathogenesis of such diseases may be related to the dysfunction of the internal organs, which eventually leads to the imbalance of qi and blood and the imcoordination of the function of the internal organs, which is the basic pathogenesis of traditional Chinese medicine.
When TCM looks at such patients, it often summarizes the syndrome, usually considering the problems of phlegm, dampness, blood stasis, and more serious problems, the problem of heat. Further research may reveal that the dysfunction of the viscera is mainly related to the excretion of the liver, the yin of the liver and the movement of the spleen. Most of them may be related to the three major dysfunctions of the liver, spleen, and kidney.
In terms of treatment, TCM emphasizes early intervention, that is, the idea of "curing the disease before it happens". For this kind of disease, there are three main aspects. The first is exercise intervention, find the exercise mode that the patient likes, such as Baduanjin, Tai Chi, jogging, swimming and other aerobic exercises, and reach a certain degree of demand. According to the explanation of modern medicine, eating more and moving less will lead to the inability to consume calories, and the accumulation of calories will lead to obesity, which will affect liver function. However, dietary conditioning also pays attention to regional and individual eating habits, and pays attention to quantitative, timed, modest, and meat and vegetable combinations. The third is to consider physical and genetic factors, although genetic intervention is more difficult, but can be combined with diet, exercise and medication to intervene.
Therefore, it is necessary to establish a research consortium and develop treatment models, standards, guidelines and methods for MAFLD. This requires continuous exploration, innovation and improvement under certain conditions to create a better model, make it easier for the people to accept and implement, and ultimately achieve good treatment results. This is the ultimate purpose of our research consortium.
