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    Dual etiology vs. MetALD: how MAFLD and MASLD address liver diseases coexistence
    (OAE Publishing, 2025) Zerehpooshnesfchi, Shadi; Lonardo, Amedeo; Fan, Jian-Gao; Elwakil, Reda; Tanwandee, Tawesak; Altarrah, Munira; Örmeci, Necati; Eslam, Mohammed
    Fatty liver disease associated with metabolic dysfunction has emerged as a significant global health challenge. This condition often coexists with other liver diseases, such as alcohol-related liver disease and viral hepatitis, complicating both diagnosis and management. To address the limitations of the non-alcoholic fatty liver disease (NAFLD) classification, two alternative frameworks have been proposed: metabolic dysfunction-associated fatty liver disease (MAFLD) in 2020 and metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. A key difference between these definitions is how they consider fatty liver disease in relation to the coexistence of other liver conditions. MAFLD adopts a dual etiology concept, creating a unified classification system that aligns with contemporary clinical and epidemiological needs. In contrast, MASLD introduces a new term, MetALD (metabolic and alcohol-related/associated liver disease), to describe patients who have both metabolic dysfunction and excessive alcohol intake. This review critically examines the clinical, research, and epidemiological implications of the differing approaches of MAFLD and MASLD, offering insights into their potential to enhance the understanding and management of multi-etiology liver diseases.
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    MAFLD: A comprehensive review of the link between metabolic dysfunction and cardiovascular risk
    (Taylor & Francis, 2025) M. Mostafa, Alaa; Pan, Ziyan; Yu, Ming-Lung; Örmeci, Necati; Fouad, Yasser; Eslam, Mohammed
    Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over 30% of the global population. It is a multisystem condition with a strong association with cardiovascular disease (CVD), the leading cause of mortality worldwide. Key shared mechanisms, including insulin resistance, systemic inflammation, oxidative stress, and genetic predisposition, couple MAFLD with increased risks of coronary artery disease, ischemic heart disease, and heart failure. Early detection via non-invasive imaging and biomarkers is crucial for effective risk stratification. Management strategies emphasize lifestyle modifications and the development of targeted pharmacotherapies addressing metabolic and inflammatory pathways. Understanding the interconnected pathogenic mechanisms facilitates personalized interventions to reduce morbidity and improve long-term outcomes. A multidisciplinary approach remains essential to prevent and manage the cardiovascular implications of MAFLD.
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    The african middle east association of gastroenterology (AMAGE) clinical practice guidelines for the diagnosis and management of metabolic dysfunction associated fatty liver disease
    (Elsevier, 2026) Fouad, Yasser; Elwakil, Reda; Sanai, Faisal M.; Ojo, Olusegun; Al Awadhi, Sameer; Ocama, Ponsiano; Abdelaty, Nadia; Al-Busafi, Said A.; Örmeci, Necati; Eslam, Mohammed
    Over the past few decades, the profile of liver diseases in Africa and the Middle East has undergone significant changes. The incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the seriousness of the situation, there is a scarcity of local or regional guidelines established to address it. This document presents the clinical practice guidelines from the African Middle East Association of Gastroenterology (AMAGE) related to the screening, diagnosis, and management of MAFLD. It addresses multiple aspects of managing this condition while taking into account local circumstances and the healthcare system's management requirements. These guidelines are intended for routine clinical use, with a specific focus on particular groups when needed.
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    The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease
    (Springer, 2025) Eslam, Mohammed; Fan, Jian-Gao; Yu, Ming-Lung; Wong, Vincent Wai-Sun; Cua, Ian Homer; Liu, Chun-Jen; Tanwandee, Tawesak; Örmeci, Necati; K. Sarin, Shiv; George, Jacob
    Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.
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    What is new in the 2025 APASL guidelines for metabolic dysfunction-associated fatty liver disease?
    (AME Publishing Company, 2026) Pan, Ziyan; Örmeci, Necati; Chen, Jinjun; Ghazinian, Hasmik; Payawal, Diana; Eslam, Mohammed
    As the global epidemics of obesity and type 2 diabetes mellitus (T2DM) continue to rise, metabolic dysfunction associated fatty liver disease (MAFLD) has become the most common chronic liver disease globally. The Asia-Pacific region is particularly affected, accounting for a significant majority of global liver-related deaths (1). To address this, the Asian Pacific Association for the Study of the Liver (APASL) has released updated clinical practice guidelines in 2025 (2). This article is a commentary focusing on the key changes and new recommendations within those guidelines, which were published in Hepatology International (2). Recognizing the limitations of the exclusionary diagnostic criteria for non-alcoholic fatty liver disease (NAFLD) and emphasizing the key role of metabolic dysfunction in disease pathogenesis, the introduction of the MAFLD definition in 2020 was a milestone in disease research and clinical practice (3-5). This shift reflects a significant evolution in our understanding of the disease, moving away from a diagnosis of exclusion towards one of inclusion based on metabolic dysfunction, recognizing the central role of metabolic factors and introducing the key concept of dual etiology, including alcohol consumption or coexisting liver diseases (6). Over the past 5 years, there have been significant advancements in understanding the disease, culminating in new knowledge, the first approved treatment, and the beginning of a new era of artificial intelligence (AI) with potential promise for hepatology. These changes stimulate the need for an updated document of the APASL guidelines for the diagnosis and management of MAFLD, which was recently released in 2025 (2). This updated guideline provides a comprehensive framework for addressing the growing burden of MAFLD in the Asia-Pacific region. This commentary aims to highlight the key aspects in this landmark document and touch on the main changes from the 2020 version (7).