Advanced diagnostic and treatment options for non-alcoholic fatty liver disease with regard to novel clinical guidelines

Non-alcoholic fatty liver disease (NAFLD) is a common chronic disease that is pathogenetically caused by metabolic dysfunction when large droplet steatosis is detected in ≥5% of hepatocytes. The condition is associated with a risk of cardiovascular diseases and progressive liver fibrosis. In 2023, an international group of experts proposed a term "steatotic liver disease associated with metabolic dysfunction" which is considered within the framework of a single "steatotic liver disease" concept. In the Russian Federation, a medical practitioner should apply an improved set of diagnostic criteria for the disease using conventional terms "NAFLD" and "non-alcoholic steatohepatitis". A decrease in incretin levels due to lower production and increased degradation by dipeptidyl peptidase-4 is an important factor of the pathogenesis. Considering a low-symptom clinical presentation, laboratory and clinical investigations are used to determine a stage and activity of the disease, to clarify presence and severity of a comorbidity, and to identify other causes of liver damage. Advanced concepts of NAFLD treatment are based on early intervention and treatment before achieving a goal (e. g., to prevent the disease progression, to ensure regression of steatosis, inflammation and fibrosis, to mitigate a cardiometabolic risk, and to prevent cancer). NAFLD treatment includes non-drug therapy and pharmacotherapy (i. e., hepatotropic drugs and drugs to treat NAFLD comorbidities with an additional hepatotropic effect). The emerging therapy for NAFLD associated with a comorbidity is an unquestionable advantage of the current clinical guidelines. In addition to lifestyle and nutrition modification, glucagon-like peptide-1 receptor agonists are used to treat NAFLD associated with type 2 diabetes mellitus and obesity. As for NAFLD therapy, semaglutide is superior to other drugs in this group. Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, steatotic liver disease associated with metabolic dysfunction, liver steatosis, type 2 diabetes mellitus, obesity, insulin resistance, glucagon-like peptide-1 receptor agonists, semaglutide. For citation: Kravchuk Yu.A. Advanced diagnostic and treatment options for non-alcoholic fatty liver disease with regard to novel clinical guidelines. RMJ. 2025;3:29–34. DOI: 10.32364/2225-2282-2025-3-6