從NAFLD到MAFLD/MASLD人類21世紀新興肝病

From NAFLD to MAFLD/MASLD, Emerging Liver Disease of the 21st Century

脂肪肝與全球肥胖流行具有緊密的關聯，而隨著全球濟發展、飲食與生活方式的改變，肥胖已成為全球重要公共衛生負擔，進而使脂肪肝也成為迫切需要關注的健康議題。嚴重脂肪肝大幅提高罹患末期肝臟疾病風險，包括肝硬化與肝癌。在台灣，肝硬化與肝癌的主要危險因子仍是慢性B型及C型肝炎病毒感染，在政府與全民的努力之下，隨著新生兒全面施打慢性B型肝炎疫苗；慢性C型肝炎新穎藥物治療的健保給付，使得病毒清除率大幅提高，並有望在近年達到世界衛生組織清除慢性肝炎病毒的目標。因此，脂肪肝將是在未來數十年誘發末期肝臟疾病的重要危險因子之一；本文針對脂肪肝流行病學研究、臨床預後及近年針對脂肪肝的一系列醫學名詞改變統整介紹，除了解該疾病的重要性之外，更進一步指出未來研究的可能方向，以盼未來能有更多的臨床與科學證據，訂立促進健康生活的方式、早期診斷和介入的預防策略。

Fatty liver disease is closely associated with the global obesity epidemic. As the global economy develops and diet and lifestyle habits change, obesity has become a significant public health burden worldwide, making fatty liver disease an urgent health issue that demands attention. Severe fatty liver disease significantly increases the risk of end-stage liver diseases, including cirrhosis and liver cancer. In Taiwan, chronic hepatitis B and C virus infections have historically been the major risk factors for cirrhosis and hepatocellular carcinoma. Due to efforts from the government and the public, including nationwide vaccination programs for newborns against chronic hepatitis B and health insurance coverage for new treatments for chronic hepatitis C, the virus clearance rate has greatly improved, raising hopes of achieving the World Health Organization's goal of eliminating chronic hepatitis viruses in the near future. Consequently, in the coming decades, fatty liver disease is expected to become one of the primary drivers of end-stage liver diseases. This article reviews previous epidemiological research on fatty liver disease, its clinical prognosis, and recent changes in medical terminology related to the disease. In addition to highlighting the importance of this emerging health issue, the article identifies potential future research directions, aiming to generate more clinical and scientific evidence to establish ways to promote healthy lifestyles, early diagnosis, and preventive intervention strategies.