Clinical Practice Guidelines for Adult MASLD in Bosnia and Herzegovina: National Recommendations for Diagnosis, Risk...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in Bosnia and Herzegovina and a major contributor to liver- and cardiovascular-related morbidity and mortality. These national guidelines provide the first country-specific, evidence-based recommendations for the diagnosis, risk stratification, and management of MASLD, covering the full disease spectrum from steatosis to cirrhosis and its complications. MASLD management is based on a coordinated, stepwise model across primary, secondary, and tertiary healthcare levels, with primary healthcare serving as the central gatekeeper and coordinator of care. Active case-finding of clinically significant fibrosis is emphasized, particularly in high-risk populations, such as individuals with type 2 diabetes mellitus or obesity. Primary healthcare plays a key role in early risk assessment through systematic evaluation of metabolic risk factors and first-line use of simple non-invasive tools, notably the FIB-4 index. A stepwise non-invasive diagnostic algorithm is recommended, with elastography (preferably vibration-controlled transient elastography or 2D shear wave elastography where available) used for further assessment in patients with indeterminate or high-risk results. Lifestyle modification and optimal management of cardiometabolic comorbidities remain the foundations of MASLD treatment. In eligible patients with type 2 diabetes mellitus and/or overweight or obesity, glucagon-like peptide-1 receptor agonists may be considered, while bariatric surgery represents an option for selected individuals with persistent obesity. Advanced MASLD, including cirrhosis, requires multidisciplinary management, surveillance for hepatocellular carcinoma, and evaluation for liver transplantation in cases of decompensation. These guidelines aim to standardize MASLD care in Bosnia and Herzegovina and strengthen the pivotal role of primary healthcare within the national MASLD care pathway.