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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...
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Related Experiment Video

Updated: May 14, 2026

Mouse Model of Metabolic Dysfunction-Associated Steatotic Liver Disease with Fibrosis
06:26

Mouse Model of Metabolic Dysfunction-Associated Steatotic Liver Disease with Fibrosis

Published on: July 18, 2025

Evidence-Based Clinical Practice Guidelines for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Norio Akuta1,2, Tomomi Kogiso1,3, Kenichi Ikejima1

  • 1Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Metabolic Dysfunction-Associated Steatotic Liver Disease 2026 (3rd Edition)", The Japanese Society of Gastroenterology/The Japan Society of Hepatology, Tokyo, Japan.

Hepatology Research : the Official Journal of the Japan Society of Hepatology
|May 12, 2026
PubMed
Summary
This summary is machine-generated.

Metabolic dysfunction-associated steatotic liver disease (MASLD) requires early risk stratification for advanced fibrosis. Guidelines recommend the FIB-4 index as a first-line tool, followed by elastography for higher-risk patients.

Keywords:
MASLD guidelinescardiometabolic risk factorsnoninvasive liver disease assessmenttreatment

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease globally.
  • MASLD progression to cirrhosis and hepatocellular carcinoma (HCC) is increasing, necessitating early risk identification.
  • Advanced fibrosis is the primary driver of liver-related morbidity and mortality in MASLD.

Purpose of the Study:

  • To provide evidence-based guidelines for diagnosing, stratifying risk, and managing MASLD in clinical practice.
  • To summarize current evidence and expert consensus on MASLD management.
  • To standardize clinical practice for MASLD in Japan.

Main Methods:

  • Systematic evaluation of existing literature.
  • Expert consensus development.
  • Review of diagnostic approaches including noninvasive fibrosis assessment, imaging, and biochemical testing.

Main Results:

  • The Fibrosis-4 (FIB-4) index is a reliable first-line noninvasive tool for fibrosis risk stratification.
  • Elevated FIB-4 or suggestive clinical features warrant secondary assessment with elastography and potential specialist referral.
  • Liver biopsy is not routine for MASLD diagnosis but essential for definitive at-risk metabolic dysfunction-associated steatohepatitis (MASH) diagnosis and inflammatory assessment.

Conclusions:

  • MASLD is a heterogeneous disease where advanced fibrosis is the key prognostic factor.
  • Early identification and risk stratification are crucial for preventing liver-related events.
  • Guidelines emphasize lifestyle modification as foundational, with pharmacological therapy for high-risk MASH.