This prevalence is escalating at an alarming rate, paralleling the growing epidemic of metabolic syndrome (MetS), encompassing obesity and type 2 diabetes mellitus (T2DM), coupled with a shift towards sedentary lifestyles and limited dietary options. Despite the increasing prevalence of MASLD, there are significant gaps in the care pathway, including screening, diagnosis, linking patients to care, and treatment. This article reviews expert guidelines and their application in clinical practice, noting the evolution of diagnostic tools and methodologies.
Despite the association with obesity, an estimated 20% of MASLD patients worldwide are non-obese, representing approximately 5% of the general population. This highlights the heterogeneity of patient presentations, suggesting that obesity may not be a definitive marker for MASLD diagnosis.
This paper also highlights the need for clinicians to address two key challenges: identifying at-risk individuals for screening and accurate MASLD diagnosis, and risk stratification to identify those with advanced fibrosis who are more likely to experience severe cardiovascular and liver-related complications. Serum biomarkers and ultrasound-based imaging techniques are rapidly advancing, providing more reliable methods for assessing MASLD patients and reducing the reliance on liver biopsies to guide treatment decisions. Both US and international medical societies have published comprehensive guidelines with actionable recommendations that can significantly contribute to the development of effective MASLD management models. Early intervention for MASLD, particularly in patients with MASH, may help prevent the need for liver transplantation, cardiovascular deaths, and liver-related morbidity and mortality. Major medical society guidelines endorse targeted MASLD screening in primary care settings for high-risk populations, specifically those exhibiting features of MetS in the absence of alternative liver disease or excessive alcohol consumption.