Background: Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed and adapted to body mass index (BMI). This study describes the impact on prevalence of the application of both criteria in overweight and lean patients. Methods: Patients who were evaluated for liver steatosis by transient elastography were included and divided according to BMI (≥25 kg/m² and <25 kg/m²) and classified as NAFLD or MAFLD, according to metabolic abnormalities. Differences in prevalence were evaluated applying both criteria. A multivariate analysis was performed to evaluate independent associations of metabolic abnormalities and liver steatosis in lean patients. Results: 3847 patients were included. In overweight patients (61%), the prevalence NAFLD was 63.6% and 65.3% for MAFLD (p = 0.22). In contrast, the prevalence of MAFLD was lower (7.9% vs. 18.3%, p ≤ 0.001) in lean patients. In this group, higher age, fasting glucose, triglycerides, and waist circumference showed independent association with liver steatosis. Conclusion: The application of NAFLD/MAFLD criteria did not show prevalence differences in overweight patients. With MAFLD criteria, the prevalence is lower in lean patients, but patients with high risk of progression of liver disease for steatosis were identified, according to their metabolic abnormalities.

Cholestasis is a condition characterized by decrease in bile flow due to progressive pathological states that lead to chronic cholestatic liver diseases which affect the biliary tree at the intrahepatic level and extrahepatic level. They induce complications such as cirrhosis, liver failure, malignancies, bone disease and nutritional deficiencies that merit close follow-up and specific interventions. Furthermore, as those conditions progress to liver cirrhosis, there will be an increase in mortality but also an important impact in quality of life and economic burden due to comorbidities related with liver failure. Therefore, it is important that clinicians understand the treatment options for cholestatic liver diseases. With a general view of therapeutic options and their molecular targets, this review addresses the pathophysiology of cholangiopathies. The objective is to provide clinicians with an overview of the safety and efficacy of the treatment of cholangiopathies based on the current evidence.

La malabsorción de lactosa y la intolerancia a la lactosa son condiciones frecuentes, clínicamente distintas. La malabsorción de lactosa se refiere al paso de este carbohidrato no digerido al colon, debido a deficiencia de lactasa, mientras que la intolerancia implica la aparición de síntomas gastrointestinales tras su ingesta, en presencia de malabsorción. La alactasia es una forma congénita rara de ausencia total de actividad de la lactasa. La hipolactasia primaria es una reducción fisiológica y genética de la lactasa en la edad adulta. La prevalencia global de malabsorción alcanza hasta dos tercios de la población, con cifras elevadas en América Latina y México. El diagnóstico puede realizarse mediante pruebas no invasivas, como la prueba de aliento con lactosa, pruebas genéticas, test de gaxilosa y prueba de tolerancia a la lactosa; o bien mediante métodos invasivos como la medición enzimática en biopsias duodenales. El tratamiento debe centrarse en controlar los síntomas sin comprometer el estado nutricional, mediante dietas bajas en lactosa, suplementos de lactasa exógena y el uso de probióticos o prebióticos. Es fundamental evitar restricciones innecesarias que puedan llevar a deficiencias nutricionales o a trastornos alimentarios, como el de restricción o evitación de la ingesta de alimentos. Un enfoque diagnóstico y terapéutico individualizado mejora la calidad de vida y el manejo clínico de estos pacientes.

Cholestasis is a condition defined as an abnormal decrease of bile flow due to progressive pathological states or cholestatic liver diseases that affect the biliary tree at intrahepatic and extrahepatic level. It induces complications such as cirrhosis, liver failure, malignancies, pruritus, fatigue, bone disease and nutritional deficiencies that merit close follow-up and specific interventions to improve quality of life. Furthermore, cholestasis can progress to end-stage liver disease and represents an entity with high morbidity and mortality; and economic burden, Therefore, it is important that clinicians understand the treatment options for cholestatic liver diseases. This review addresses the pathophysiology of cholangiopathies, a general view of current treatments and their molecular targets, and a specific review of those groups of drugs. The objective is to provide clinicians with an overview of the current treatment of cholangiopathies based on evidence on its efficacy and safety.