| Abstract [eng] |
This thesis examines steatotic liver disease as it is understood today – not only as a common liver disorder, but also as a condition whose meaning has shifted with changing nomenclature, an expanding metabolic context, and a more nuanced view of its prognosis. It reviews the current classification of the disease, its epidemiology and major risk groups, the mechanisms underlying progression, and the evidence behind diagnosis, non-invasive risk stratification, management, complications, and extrahepatic associations. The main body of evidence was drawn from the PubMed and MEDLINE databases. Primary sources were complemented with international clinical guidelines, consensus statements, systematic reviews, randomised clinical trials, and large observational studies. Recent sources were prioritised, but older landmark studies were also included where they helped to present understanding, especially in relation to prognosis. An important message from the reviewed literature is not simply that steatotic liver disease is common – since it affects roughly one third of adults worldwide, but that it is often underestimated because it can remain clinically silent while fibrosis is already developing. This is particularly relevant in people with obesity, type 2 diabetes mellitus, and other cardiometabolic risk factors, yet the disease does not fit neatly into those groups alone. Normal aminotransferase levels may offer false reassurance, whereas fibrosis stage repeatedly stands out as the strongest determinant of outcome. That shift in emphasis has changed practice. The main issue is no longer the mere presence of steatosis, but determining who is already at risk of progression. Lifestyle and its adjustments remain fundamental, although the field has clearly moved beyond a lifestyle-only model. New pharmacological options and bariatric-metabolic surgery have widened the therapeutic horizon, while cardiovascular disease, chronic kidney disease, and extrahepatic malignancy make it clear that the context is broader than the liver itself. At present, steatotic liver disease is best approached as a systemic metabolic condition with hepatic expression. It is a diagnosis that rewards earlier recognition and more careful attention to fibrosis risk than used to be the case. |
