Characterization and Management of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)

Characterization and Management of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Through an Individualized Nutritionnal Approach and Semaglutide Therapy.

The goal of this clinical trial is to improve the treatment of hepatic steatosis associated with obesity with pharmacological and nutritionnal approaches. The main question it aims to answer is:

Does an individualized nutritionnal approach with a dietician combined with medication targeting obesity is the most efficient way to treat hepatic steatosis associated with obesity?

Participants will either participate in one of three groups:

• Nutrition: Participant will only have a regular follow-up with a registered dietician;
• Nutrition + Semaglutide: Participants will start a new medication targeting obesity and will have a regular follow-up with a registered dietician;
• Semaglutide: Participants will start a new medication targeting obesity.

Participants in each group will be followed during a year for 4 timepoints (0, 3, 6 and 12 months). Blood and feces samples, anthropometric measures, transient elastography measurements and health questionnaires will be assessed at each timepoint.

The nutritionnal intervention targeting hepatic steastosis associated with obesity will use conclusions from a systematic review we conducted on nutritionnal approaches to treat liver steatosis.

Inclusion Criteria:

• Body mass index between 30 and 50 kg/m2;
• Stade 2 or 3 (S2 or S3) hepatic steatosis with or without liver fibrosis.

Exclusion Criteria:

• Type 1 diabetes diagnosis;
• Alcohol consumption exceeding recommendations [>140 g/week (women) and >210 g/week (men)];
• Known chronic hepatic disease non-steatotic at the entry of the study (Wilson's disease, hemochromatosis, alpha-1-antitrypsin deficiency, viral hepatitis, auto-immune hepatitis, etc.);
• Pharmacological treatment targeting obesity active or ended in the last 3 months;
• Bariatric surgery;
• Gastro-intestinal pathologies (GI cancers, IBD, etc.);
• Capsulated probiotics consumption;
• Antibiotic treatment in the last 3 months;
• Pregnancy;
• Cirrhosis diagnosis (hepatic decompensation).