The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities

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Abstract

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine – Fund PROFMEDFORUM.

The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis – an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

About the authors

Marina V. Maevskaya

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: liver.orc@mail.ru
ORCID iD: 0000-0001-8913-140X
Scopus Author ID: 6504258180

д-р мед. наук, проф., врач-гастроэнтеролог

Russian Federation, Moscow

Yulia V. Kotovskaya

Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-1628-5093

д-р мед. наук, проф., зам. дир. по научной работе            

Russian Federation, Moscow

Vladimir T. Ivashkin

Sechenov First Moscow State Medical University (Sechenov University)

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-6815-6015

акад. РАН, д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней лечебного фак-та, дир. клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии, гл. внештатный специалист-гастроэнтеролог

Russian Federation, Moscow

Olga N. Tkacheva

Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-4193-688X

д-р мед. наук, проф., дир., гл. внештатный специалист-гериатр Минздрава России

Russian Federation, Moscow

Ekaterina A. Troshina

Endocrinology Research Centre

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-8520-8702

д-р мед. наук, проф., чл.-кор. РАН, зам. дир.

Russian Federation, Moscow

Marina V. Shestakova

Endocrinology Research Centre

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-5057-127X

акад. РАН, д-р мед. наук, проф., зам. дир.

Russian Federation, Moscow

Valeriy V. Breder

Blokhin National Medical Research Center of Oncology

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-6244-4294

д-р мед. наук, вед. научный сотр.

Russian Federation, Moscow

Natalia I. Geyvandova

Stavropol State Medical University

Email: liver.orc@mail.ru
ORCID iD: 0000-0001-5920-5703

д-р мед. наук, проф. каф. госпитальной терапии

Russian Federation, Stavropol

Vladimir L. Doshchitsin

Pirogov Russian National Research Medical University

Email: liver.orc@mail.ru
ORCID iD: 0000-0001-8874-4108

д-р мед. наук, проф., каф. кардиологии

Russian Federation, Moscow

Ekaterina N. Dudinskaya

Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University

Email: liver.orc@mail.ru
ORCID iD: 0000-0001-7891-6850

канд. мед. наук, зав. лаб. возрастных метаболических эндокринных нарушений

Russian Federation, Moscow

Ekaterina V. Ershova

Endocrinology Research Centre

Email: yu99pol06@rambler.ru
ORCID iD: 0000-0002-6220-4397

канд. мед. наук, вед. науч. сотр. отд. терапевтической эндокринологии

Russian Federation, Moscow

Khava B. Kodzoeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: liver.orc@mail.ru
ORCID iD: 0000-0001-7510-6553

аспирант каф. пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

Russian Federation, Moscow

Ksenia A. Komshilova

Endocrinology Research Centre

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-6624-2374

канд. мед. наук, врач-эндокринолог отд. терапевтической эндокринологии

Russian Federation, Moscow

Natalia V. Korochanskaya

Kuban State Medical University

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-5538-9418

д-р мед. наук, проф. каф. хирургии, гл. гастроэнтеролог Минздрава Краснодарского края

Russian Federation, Krasnodar

Alexander Yu. Mayorov

Endocrinology Research Centre

Email: liver.orc@mail.ru
ORCID iD: 0000-0001-5825-3287

д-р мед. наук, зав. отд. прогнозирования и инноваций диабета, проф. каф. диабетологии и диетологии

Russian Federation, Moscow

Ekaterina E. Mishina

Endocrinology Research Centre

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-5371-8708

науч. сотр. отд. прогнозирования и инноваций диабета

Russian Federation, Moscow

Maria Yu. Nadinskaya

Sechenov First Moscow State Medical University (Sechenov University)

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-1210-2528

канд. мед. наук, доц. каф. пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

Russian Federation, Moscow

Igor G. Nikitin

Pirogov Russian National Research Medical University; National Medical Research Center "Treatment and Rehabilitation Center"

Email: liver.orc@mail.ru
ORCID iD: 0000-0003-1699-0881

д-р мед. наук, проф., зав. каф. госпитальной терапии

Russian Federation, Moscow; Moscow

Nana V. Pogosova

National Medical Research Center of Cardiology

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-4165-804X

д-р мед. наук, проф., зам. ген. дир. по научно-аналитической работе и профилактической кардиологии

Russian Federation, Moscow

Aida I. Tarzimanova

Sechenov First Moscow State Medical University (Sechenov University)

Email: liver.orc@mail.ru
ORCID iD: 0000-0001-9536-8307

д-р мед. наук, проф. каф. факультетской терапии

Russian Federation, Moscow

Minara Sh. Shamkhalova

Endocrinology Research Centre

Email: liver.orc@mail.ru
ORCID iD: 0000-0002-3433-0142

д-р мед. наук, зав. отд-нием диабетической болезни почек и посттрансплантационной реабилитации

Russian Federation, Moscow

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