Evidence-based clinical practice guidelines for metabolic dysfunction-associated steatotic liver disease (MASLD)...

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.
• Early identification of advanced fibrosis is crucial for preventing liver-related events.

Purpose of the Study:

• To provide practical recommendations for MASLD diagnosis, risk stratification, and management.
• To summarize current evidence and expert consensus for clinical practice.
• To standardize MASLD management in Japan.

Main Methods:

• Systematic literature evaluation and expert consensus.
• Review of diagnostic approaches including noninvasive fibrosis assessment, imaging, and biochemical testing.
• Assessment of indications for specialist referral.

Main Results:

• Advanced fibrosis is the primary determinant of liver-related morbidity and mortality in MASLD.
• The Fibrosis-4 (FIB-4) index is a reliable first-line noninvasive tool for fibrosis risk stratification.
• Secondary assessment with elastography and specialist referral are recommended for elevated FIB-4 or suggestive clinical features.

Conclusions:

• Liver biopsy is not routinely required for MASLD diagnosis but is essential for diagnosing at-risk metabolic dysfunction-associated steatohepatitis (MASH), assessing inflammation, and resolving discrepancies.
• Lifestyle modification is foundational; pharmacological therapy is considered for high-risk MASH.
• These guidelines aim to standardize clinical practice for evidence-based MASLD management.