Since 2020, the international community has successively proposed new nomenclatures for metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD). In 2024, the Chinese Society of Hepatology updated and published the Guideline for the prevention and treatment of metabolic dysfunction-associated (non-alcoholic) fatty liver disease (version 2024). This review deeply analyzes the differences between MASLD and MAFLD in terms of concept, definition framework, and clinical management. On this basis, it provides an in-depth interpretation of the updated highlights and features of the working definition in the 2024 updated Chinese guideline.

Non-alcoholic fatty liver disease (NAFLD) is a chronic non-communicable disease epidemic which is highly heterogeneous and has reciprocal causation with metabolic disorders, which jointly promote the onset of end-stage of liver diseases, cardiovascular-kidney-metabolic diseases and malignant tumors; hence, it is also referred to as metabolic associated fatty liver disease (MAFLD). The MAFLD characteristics and outcomes cannot be accurately predicted by the classification based on obesity and non-alcoholic steatohepatitis (NASH). Unfortunately, drug development that exclusively focuses on NASH has frequently resulted in failure. Currently, there is an urgent need to strengthen research on clinical classification and precise intervention for MAFLD based on disease outcomes. It is anticipated that the prevention and treatment of cardiovascular-kidney-liver-metabolic diseases will be addressed by emphasizing the diagnosis and intervention of metabolic dysfunction and progressive liver fibrosis, as well as treatment strategies targeting obesity/sarcopenic obesity, thereby alleviating the disease burden and improving patient prognosis.

Metabolic associated fatty liver disease (MAFLD) has become one of the leading causes of cirrhosis and hepatocellular carcinoma. Therefore, identifying high-risk MAFLD patients accurately and providing monitoring and treatment is crucial.Invasive liver biopsy has inherent defects such as high costs, low patient acceptance, and significant inconsistencies in readings between individual pathologists. Non-invasive testing technologies have become a core measure in the management of MAFLD. This paper summarizes and discusses the latest application progress of non-invasive testing technologies in the field of MAFLD and explores the key aspects that urgently need improvement, with the aim of providing clinical doctors with references for effectively assessing the progression trends of MAFLD patients and implementing intervention treatments.

With the prevalence of obesity and metabolic syndrome， metabolic associated fatty liver disease （MAFLD） has become one of the most common chronic liver diseases in China and globally. Traditional diagnostic and monitoring methods rely on liver biopsy， imaging techniques， and serological markers， and their application is limited by invasiveness， high costs， and insufficient sensitivity. In recent years， the rapid development of artificial intelligence （AI） technology in the medical field has provided new ideas for the diagnosis and treatment of MAFLD. This article explores the application of AI technology in areas such as models for the diagnosis of MAFLD， the prediction of disease progression， and digital therapeutics， in order to provide a reference for the diagnosis and management of MAFLD.

Non-alcoholic fatty liver disease (NAFLD) is a chronic non-communicable disease epidemic which is highly heterogeneous and has reciprocal causation with metabolic disorders, which jointly promote the onset of end-stage of liver diseases, cardiovascular-kidney-metabolic diseases and malignant tumors; hence, it is also referred to as metabolic associated fatty liver disease (MAFLD). The MAFLD characteristics and outcomes cannot be accurately predicted by the classification based on obesity and non-alcoholic steatohepatitis (NASH). Unfortunately, drug development that exclusively focuses on NASH has frequently resulted in failure. Currently, there is an urgent need to strengthen research on clinical classification and precise intervention for MAFLD based on disease outcomes. It is anticipated that the prevention and treatment of cardiovascular-kidney-liver-metabolic diseases will be addressed by emphasizing the diagnosis and intervention of metabolic dysfunction and progressive liver fibrosis, as well as treatment strategies targeting obesity/sarcopenic obesity, thereby alleviating the disease burden and improving patient prognosis.

Metabolic associated fatty liver disease (MAFLD) has become one of the leading causes of cirrhosis and hepatocellular carcinoma. Therefore, identifying high-risk MAFLD patients accurately and providing monitoring and treatment is crucial.Invasive liver biopsy has inherent defects such as high costs, low patient acceptance, and significant inconsistencies in readings between individual pathologists. Non-invasive testing technologies have become a core measure in the management of MAFLD. This paper summarizes and discusses the latest application progress of non-invasive testing technologies in the field of MAFLD and explores the key aspects that urgently need improvement, with the aim of providing clinical doctors with references for effectively assessing the progression trends of MAFLD patients and implementing intervention treatments.

With the prevalence of obesity and metabolic syndrome,non-alcoholic fatty liver disease(NAFLD)has replaced chronic hepatitis B as the leading chronic liver disease in China.In recent years,continuous exploration of the epidemiology and natural history of this disease,proposals for renaming,rapid advancements in diagnostic techniques,and continuous updates in treatment methods have propelled significant progress in the related diagnostic and therapeutic fields.Recently,experts in the Chinese Society of Hepatology revised the"Guidelines for the Prevention and Treatment of Non-Al-coholic Fatty Liver Disease(2018 Updated Version)"and published the"Guidelines for the Prevention and Treatment of Metabolic Dysfunction-associated(Non-alcoholic)Fatty Liver Disease(Version 2024)".The updated guideline provides guiding recommendations on important clinical issues such as renaming and sorting,screening and monitoring,diagnosis and assessment,treatment,and follow-up for this disease.This article aims to interpret the key updates in this guideline to help clinical practitioners gain a more comprehensive understanding and apply them to guide clinical practice.

Objective:To investigate the clinical and genetic characteristics and predictive role of the severe liver disease phenotype in patients with hepatolenticular degeneration (HLD).Methods:Inpatients with HLD confirmed at Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine from January 1989 to December 2022 were selected as the research subjects. Clinical classification was performed according to the affected organs. Patients with liver disease phenotypes were classified into the liver disease group and further divided into the severe liver disease group and the ordinary liver disease group. The clinical characteristics and genetic variations were compared in each group of patients. The predictive indicators of patients with severe liver disease were analyzed by multiple regression. Statistical analysis was performed using the t-test, Mann-Whitney U test, or χ2 test according to different data. Results:Of the 159 HLD cases, 142 were in the liver disease group (34 in the severe liver disease group and 108 in the ordinary liver disease group), and 17 were in the encephalopathy group. The median age of onset was statistically significantly different between the liver disease group and the encephalopathy group [12.6 (7.0, 13.3) years versus 16.9 (11.0, 21.5) years, P<0.01]. 156 ATP7B gene mutation sites were found in 83 cases with genetic testing results, of which 54 cases carried the p.Arg778Leu gene mutation (allele frequency 46.2%). Compared with patients with other types of gene mutations ( n=65), patients with homozygous p.Arg778Leu mutations ( n=18) had lower blood ceruloplasmin and albumin levels, a higher prognostic index, Child-Pugh score, an international normalized ratio, and prothrombin time ( P<0.05). Hemolytic anemia, corneal K-F ring, homozygous p.Arg778Leu mutation, and multiple laboratory indexes in the severe liver disease group were statistically significantly different from those in the ordinary liver disease group ( P<0.05). Multivariate logistic regression analysis showed that the predictive factors for severe liver disease were homozygous p.Arg778Leu mutation, total bilirubin, and bile acids ( ORs=16.512, 1.022, 1.021, 95% CI: 1.204-226.425, 1.005-1.039, and 1.006-1.037, respectively, P<0.05). The drawn ROC curve demonstrated a cutoff value of 0.215 3, an AUC of 0.953 2, and sensitivity and specificity of 90.91% and 92.42%, respectively. Conclusion:Liver disease phenotypes are common in HLD patients and have an early onset. Total bilirubin, bile acids, and the homozygous p.Arg778Leu mutation of ATP7B is related to the severity of liver disease in HLD patients, which aids in predicting the occurrence and risk of severe liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD), also called non-alcoholic fatty liver disease, is the most epidemic chronic liver disease worldwide. Metabolic dysfunction-associated steatohepatitis (MASH) is the critical stage of MASLD, and early diagnosis and treatment of MASH are crucial for reducing the incidence of intrahepatic and extrahepatic complications. So far, pharmacotherapeutics for the treatment of MASH are still a major challenge, because of the complexity of the pathogenesis and heterogeneity of MASH. Many agents under investigation have shown impressive therapeutic effects by targeting different key pathways, including the attenuation of steatohepatitis or fibrosis or both. It is notable that thyroid hormone receptor-β agonist, resmetirom has become the first officially approved drug for treating MASH with fibrosis. Other agents such as peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 analogs, and fibroblast growth factor 21 analogs are awaiting approval. This review focuses on the current status of drug therapy for MASH and summarizes the latest results of new medications that have completed phase 2 or 3 clinical trials, and presents the future directions and difficulties of new drug research for MASH.

Inflammatory liver injury is the initiating factor for various chronic liver diseases.It can involve the whole body,and on the contrary,systemic diseases may also lead to liver injury.The diagnosis and treatment of liver disease should not only consider the liver disease itself,but also understand the interaction between various systemic diseases and inflammatory liver injury and related pathophysiological mechanisms.Therefore,the diagnosis and treatment of liver injury often require multidisciplinary discussions and joint decision-making.One of the important links in the treatment of liver disease is to protect and maintain the stability of liver function,and how to carry out anti-inflammatory and liver-protecting treatment should be considered during the development of treatment strategies.Bicyclol is a chemical agent independently developed by China and is used for the treatment of inflammatory liver injury.Bicyclol has a good clinical effect in the prevention and treatment of inflammatory liver injury due to various causes and has been registered and listed in nine countries along the Belt and Road.Therefore,we have organized domestic experts from relevant disciplines all over the country to summarize the advances in the multidisciplinary clinical application of bicyclol in the prevention and treatment of inflammatory liver injury based on related guidelines/consensus statements/clinical pathways and evidence-based medicine and with reference to the clinical practice in China,in order to improve the scientific and standard use of bicyclol in clinical practice and the prevention and treatment of inflammatory liver injury in each discipline.