Madian A. Essential phospholipids and enzyme-based staging in nonalcoholic fatty liver disease: A call to action. World J Hepatol 2025; 17(11): 110725 [DOI: 10.4254/wjh.v17.i11.110725]
Corresponding Author of This Article
Ali Madian, MD, PhD, Associate Professor, Consultant, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University-Assiut, Al Walideyah Al Bahreyah, Assiut 71524, Egypt. a.madian@azhar.edu.eg
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Gastroenterology & Hepatology
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Dec 4, 2025
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Publication Name
World Journal of Hepatology
ISSN
1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Madian A. Essential phospholipids and enzyme-based staging in nonalcoholic fatty liver disease: A call to action. World J Hepatol 2025; 17(11): 110725 [DOI: 10.4254/wjh.v17.i11.110725]
World J Hepatol. Nov 27, 2025; 17(11): 110725 Published online Nov 27, 2025. doi: 10.4254/wjh.v17.i11.110725
Essential phospholipids and enzyme-based staging in nonalcoholic fatty liver disease: A call to action
Ali Madian
Ali Madian, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University-Assiut, Assiut 71524, Egypt
Author contributions: Madian A conceptualized the editorial, drafted the manuscript, reviewed and revised the content, and approved the final version for submission.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Madian, MD, PhD, Associate Professor, Consultant, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University-Assiut, Al Walideyah Al Bahreyah, Assiut 71524, Egypt. a.madian@azhar.edu.eg
Received: June 13, 2025 Revised: July 8, 2025 Accepted: September 2, 2025 Published online: November 27, 2025 Processing time: 167 Days and 18.1 Hours
Abstract
Nonalcoholic fatty liver disease, recently termed metabolic dysfunction-associated steatotic liver disease, affects 25% of adults globally, with a prevalence reaching 93% in obese individuals. The MANPOWER study, a post hoc analysis of 2843 Russian patients with newly diagnosed nonalcoholic fatty liver disease, evaluated Essentiale Forte N® [essential phospholipids (EPLs)] therapy and a liver enzyme-based staging algorithm. Using generalized linear regression and McNemar tests, EPLs reduced liver enzyme levels (alanine aminotransferase: -20.4 U/L, aspartate aminotransferase: -16.9 U/L, gamma-glutamyl transferase: -17.1 U/L at 24 weeks, P < 0.001) and improved ultrasonography findings (76.8% reduction in hyperechogenicity, P < 0.001). A logistic regression algorithm using alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels achieved 72.3% accuracy, 75.6% sensitivity, 71.0% specificity, and an area under the receiver operating characteristic curve of 0.74 (95% confidence interval: 0.71-0.77) for identifying nonalcoholic steatohepatitis. These findings advocate EPLs as a safe, effective therapy and propose a scalable diagnostic tool, urging validation to reduce the reliance on biopsy.
Core Tip: The MANPOWER study demonstrated that Essentiale Forte N® reduces liver enzyme levels (alanine aminotransferase: 20-37 U/L, aspartate aminotransferase: 17-29 U/L, gamma-glutamyl transferase: 17-24 U/L, P < 0.001) and improves ultrasonography findings in patients with nonalcoholic fatty liver disease, with greater efficacy in severe cases. A liver enzyme-based algorithm offers 72.3% accuracy for noninvasive staging, prompting clinicians to adopt essential phospholipids and researchers to refine scalable diagnostics to address nonalcoholic fatty liver disease’s global burden.
