Epidemiology and Clinical Outcomes of Metabolic(Dysfunction)-associated Fatty Liver Disease

Metabolic(dysfunction)-associated fatty liver disease(MAFLD)is currently the most common chronic liver disease and affects at least a quarter of the global adult population.It has rapidly become one of the leading causes of hepatocellular carcinoma and cirrhosis in Western countries.In this review,we discuss the nomenclature and definition of MAFLD as well as its prevalence and incidence in different geographical regions.Although cardiovascular disease remains the leading cause of death in MAFLD patients,the proportion of patients dying from hepatic complications increases sharply as the disease progresses to advanced liver fibrosis and cirrhosis.In addition,patients with MAFLD are at increased risk of various extrahepatic cancers.Although a causal relationship between MAFLD and extrahepatic cancers has not been established,clinicians should recognize the association and consider cancer screening(e.g.,for colorectal cancer)as appropriate.

Non-invasive tests of non-alcoholic fatty liver disease

For the detection of steatosis,quantitative ultrasound imaging techniques have achieved great progress in past years.Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis.Some blood biomarkers correlate with non-alcoholic steatohepatitis,but the accuracy is modest.Regarding liver fibrosis,liver stiffness measurement by transient elastography(TE)has high accuracy and is widely used across the world.Magnetic resonance elastography is marginally better than TE but is limited by its cost and availability.Several blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment response.This article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease(NAFLD).Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD,assess its severity,and predict the prognosis.Further studies are needed to determine the role of the tests as monitoring tools.We cannot overemphasize the importance of context in selecting appropriate tests.

Overview of methodologies and statistical strategies in observational studies and meta-analyses on the risk of hepatocellular carcinoma in patients with chronic hepatitis B on entecavir or tenofovir therapy

Entecavir(ETV)and tenofovir disoproxil fumarate(TDF)are first-line antiviral therapies for patients with chronic hepatitis B(CHB)and reduce the risk of disease progression and liver-related complications,as well as improve survival by effectively suppressing viral replication.Nevertheless,since the first publication in 2019 on a lower risk of hepatocellular carcinoma(HCC)in Korean patients receiving TDF than those receiving ETV,the topic has remained a hot and unsettled debate.Multiple studies and meta-analyses have yielded conflicting results.As HCC takes time to develop,studies are mainly observational to benefit from a larger sample size and longer follow-up that provides a higher statistical power to compare the two treatments.However,TDF was available to CHB patients a few years later than ETV in most countries,thus leading to a difference in follow-up duration.Moreover,despite studying the same topic,the difference in data sources and available parameters,inclusion and exclusion criteria,and use of statistical methods complicated the interpretation and comparison of the findings and contributed to between-study heterogeneity in meta-analyses.This review describes some caveats in interpreting and comparing the results from these observational studies and meta-analyses.Future studies should explore better designed observational studies with high-quality data sources,and aggregation of patient data in metaanalysis to tackle between-study heterogeneity.