Este protocolo aborda a doença hepática esteatótica associada a disfunção metabólica (MASLD) em adultos com sobrepeso ou obesidade — definida como índice de massa corporal de ≥25 kg/m² em adultos não asiáticos ou ≥23 kg/m² em adultos de etnia asiática. O IMC elevado é central para a atividade da doença nessa população e é o principal alvo terapêutico.
O manejo centra-se na perda de peso induzida por terapia dietética e comportamental, incluindo melhorias na qualidade da dieta e atividade física estruturada — o regimento completo com todas as recomendações está no protocolo abaixo.
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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