Asia-Pacific perspectives on the steatotic liver disease (SLD) reclassification: balancing terminology, diagnostic...

The global transition from non-alcoholic fatty liver disease (NAFLD) to steatotic liver disease (SLD), encompassing metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated steatohepatitis (MASH), and metabolic dysfunction-associated alcohol-related liver disease (Met-ALD), aims to improve pathophysiologic accuracy and reduce stigma. Asia-Pacific countries have been early adopters of metabolic dysfunction-associated fatty liver disease (MAFLD), which has demonstrated strong prognostic performance and operational simplicity. How MASLD implementation aligns with existing MAFLD-oriented clinical practice in the region remains unclear.

A 27-item cross-sectional survey was distributed to clinicians across 19 Asia-Pacific regions and beyond to assess readiness to adopt SLD terminology. Respondents evaluated willingness across clinical practice, research, patient education, and stigma-reduction domains. Additional items explored metabolic syndrome (MetS) definitions, alcohol-assessment practices, and access to fibrosis testing. Multivariable ordered logistic regression identified predictors of adoption.

Among 462 respondents, gastroenterology and hepatology specialists demonstrated greater willingness to adopt MASLD across clinical management (p = 0.0194), research (p = 0.0208), and patient education (p = 0.0157). Alcohol assessment showed operational gaps, with lower effort among non-specialists (≥1 min: 26.5 vs 35.6%), potentially complicating Met-ALD classification. Definitions of MetS were heterogeneous, and access to fibrosis assessment differed, with specialists reporting higher use of vibration-controlled transient elastography, magnetic resonance elastography, and corrected T1 imaging (adjusted odds ratio 2.18-2.41).

Successful regional implementation of MASLD will require alignment with MAFLD-informed practice, improved exposure to evolving nomenclature, operationally feasible workflows, strengthened alcohol assessment, and enhanced access to fibrosis testing to ensure coherent SLD adoption across primary care and specialist settings.