Burden and Health System Challenges in MASLD Across East and Southeast Asia: A Narrative Review

Area of Science:

• Hepatology and Gastroenterology
• Public Health and Epidemiology
• Metabolic Disorders

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant and increasing public health challenge in East and Southeast Asia.
• Rapid urbanization, dietary shifts, and rising rates of obesity, diabetes, and hypertension are key drivers of MASLD in the region.
• Unique metabolic profiles and resource limitations in Asian populations contribute to underdiagnosis and delayed management of MASLD.

Purpose of the Study:

• To review the current burden and risk factors of MASLD in East and Southeast Asia.
• To identify population-specific challenges and public health gaps in MASLD management within the region.
• To provide insights for developing region-specific strategies to combat the growing prevalence of MASLD.

Main Methods:

• A comprehensive literature search was performed in PubMed, ScienceDirect, and Google Scholar for studies published between 2010 and 2024.
• Keywords included "MASLD," "MAFLD," "NAFLD," "fatty liver disease," "East Asia," "Southeast Asia," "risk factors," and "public health."
• Data from eligible studies (original research, cohort studies, reviews, meta-analyses) were thematically synthesized, focusing on prevalence, determinants, vulnerable groups, and health system challenges.

Main Results:

• MASLD prevalence varies across East and Southeast Asia, higher in urban and high-income areas.
• Environmental factors, dietary changes, and socioeconomic disparities significantly influence MASLD patterns alongside metabolic drivers.
• Vulnerable subpopulations (children, elderly, lean MASLD, comorbidities) face unique risks, often exacerbated by limited regional data. Health system gaps include poor primary care integration, diagnostic access variability, and low provider awareness.

Conclusions:

• MASLD is an underrecognized and escalating public health issue in East and Southeast Asia.
• Improving early detection and long-term outcomes requires addressing diagnostic gaps and enhancing primary care capacity for MASLD.
• Mitigating the future burden of MASLD necessitates region-specific strategies and strengthened health systems for diverse Asian populations.