Modern aspects of management of patients with metabolic dysfunction-associated steatotic liver disease

In 2023, a new nomenclature and pathophysiology were developed, a definition and diagnostic criteria for MASLD (metabolic dysfunction-associated steatotic liver disease) were proposed. The diagnostic criteria for MASLD were recommended to be the presence of liver steatosis and at least one of five cardiometabolic factors: 1) Quetelet index >25; waist circumference >94 cm for men and >80 cm for women; 2) fasting glucose content >5.6 mmol/l; 3) blood pressure >130/85 mm Hg; 4) blood triglyceride levels >1.7 mmol/l; 5) blood high-density lipoprotein cholesterol < 1 mmol/l. Basic treatment of patients with MASLD includes diet modification, increased physical activity and weight loss. Drug therapy is mainly required for patients with a high probability of disease progression (the presence of comorbid conditions, diagnosis of steatohepatitis and severe liver fibrosis). The first drug approved by the FDA for the treatment of metabolically associated steatohepatitis (MASH) was the THR-β agonist resmetirom. The above innovations have led to a desire to revise the prescription of pioglitazone, metformin, vitamin E and drugs with cytoprotective activity for the treatment of MASH in new international guidelines. At the same time, the 2024 Russian guidelines for the management of patients with MASLD leave room for the use of a large group of drugs for the treatment of various phenotypes of MASLD. In this review, we draw attention to polyunsaturated fatty acid (PUFA) drugs, one of which is Essentiale forte N, which have a broad evidence base. The potential use of PUFAs in the treatment of MASH is discussed in the 2024 European Association for the Study of the Liver guidelines and the new 2025 international consensus on MASH.

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