Este protocolo aborda la enfermedad hepática esteatótica asociada a disfunción metabólica (MASLD) en adultos con sobrepeso u obesidad — definido como un índice de masa corporal de ≥25 kg/m² en adultos no asiáticos o ≥23 kg/m² en adultos de etnia asiática. El IMC elevado es central para la actividad de la enfermedad en esta población y es el principal objetivo terapéutico.
El manejo se centra en la pérdida de peso inducida por terapia dietética y conductual, incluyendo mejoras en la calidad de la dieta y actividad física estructurada — el régimen completo con todas las recomendaciones se encuentra en el protocolo a continuación.
DOI: 10.1016/j.jhep.2024.04.031
In adults with MASLD, dietary and behavioural therapy-induced weight loss should be recommended to improve liver injury, as assessed histologically or non-invasively (LoE 1, strong recommendation, strong consensus).
In adults with MASLD and overweight, dietary and behavioural therapy-induced weight loss should aim at a sustained reduction of >5% to reduce liver fat, 7-10% to improve liver inflammation, and >10% to improve fibrosis (LoE 2, strong recommendation, strong consensus).
In adults with MASLD, improving diet quality (similar to the Mediterranean dietary pattern), limiting the consumption of ultra-processed food (rich in sugars and saturated fat) and avoiding sugar-sweetened beverages should be recommended to improve histologically or non-invasively assessed liver injury (LoE 2, strong recommendation, strong consensus).
In adults with MASLD, physical activity and exercise should be recommended to reduce steatosis, tailored to the individual's preference and ability (preferably >150 min/week of moderate or 75 min/week of vigorous-intensity physical activity) (LoE 1, strong recommendation, strong consensus).
Overweight: BMI of 25-29.9 kg/m² (non-Asian) or 23-24.9 (Asian). Obesity: >30 kg/m² (non-Asian), >25 kg/m² (Asian).
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