Key research and implementation priorities for obesity-related liver disease
Implementation priority
Action required
Refining obesity phenotyping
There is a clear need for robust classification methods that integrate metabolic, anthropometric, and genomic information to better distinguish obesity subtypes and predict liver disease risk. The incorporation of advanced imaging techniques, such as MRI-based proton density fat fraction (PDFF) measurement, may further refine these stratifications.
Clarifying the gut-liver axis
Research is needed to understand how dysbiosis, increased intestinal permeability, and altered bile acid signaling contribute to liver inflammation and fibrosis. Future investigations should explore whether interventions like probiotics, prebiotics, and fecal microbiota transplantation can confer durable benefits.
Long-term evaluations of emerging therapies
Numerous drugs targeting pathways from insulin resistance (IR) to fibrogenesis are under development. Longitudinal studies examining how these agents influence outcomes, especially cirrhosis and hepatocellular carcinoma, are vital, as are evaluations of combination therapies that may yield synergy without excessive toxicity.
Cost-effective, patient-centered models of care
Integrating novel diagnostics and treatments into clinical practice must be balanced against cost considerations. Research is necessary to explore how best to incorporate telemedicine, digital health tools, and multidisciplinary teams in ways that optimize patient adherence and outcomes while minimizing healthcare expenditures.
Preventive and public health strategies
Effective management of obesity-related liver disease also requires upstream interventions that address environmental and socio-economic factors underpinning obesity itself. Enhanced public policies, improved nutritional labeling, and community-based programs have the potential to reduce the overall disease burden if implemented broadly and supported through sustained funding.
The graphical abstract was generated using Servier Medical Art, provided by Servier. The authors would like to express their gratitude to Sabine Weiskirchen from the University Hospital Aachen for preparing Figure 2 of this review. Additionally, we would like to extend our sincere thanks to the World Obesity Federation for assisting and granting permission to publish Figure 1B and the Supplementary material.
AI and AI-assisted Technologies: The authors of this article used the Large Language Model RWTHgpt by RWTH Aachen University exclusively for minor translations and grammatical corrections in this work. All sentences revised by RWTHgpt were reviewed and verified by the authors.
Author contributions
AL and RW: Conceptualization, Writing—original draft, Writing—review & editing. Both authors read and approved the submitted version.
Conflicts of interest
Amedeo Lonardo who is the Associate Editor of Exploration of Medicine had no involvement in the decision-making or the review process of this manuscript. Another author declares that there are no conflicts of interest.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
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