Updated recommendations on metabolic dysfunction-associated steatotic liver disease

The updated recommendations on metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) emphasize the importance of early detection and clear terminology. MASLD includes hepatic fat accumulation linked to cardiometabolic factors, while its severe inflammatory form is termed metabolic dysfunction-associated steatohepatitis (MASH). Management follows a structured approach: first, clinicians identify risk factors such as obesity, diabetes, alcohol intake, and abnormal liver enzymes. Risk stratification relies on non-invasive tests (e.g., FIB-4 index or FibroScan®) to distinguish simple steatosis from progressive forms that can advance to cirrhosis and hepatocellular carcinoma. Precise assessment of alcohol consumption is also crucial, as it distinguishes MetALD (a combination of metabolic factors and alcohol use) from ALD (significant alcohol use), ensuring tailored treatment. Therapy priorities include lifestyle modifications (weight reduction, dietary changes, and regular physical activity) along with optimal management of comorbidities (diabetes, dyslipidemia) and targeted surveillance for complications. Pharmacological options, including potential future therapies targeting MASH, may be considered in cases of advanced fibrosis. Ultimately, these recommendations highlight the need for a multidisciplinary approach, combining hepatologists, diabetologists, and other specialists, to effectively identify and manage MASLD/MASH and improve long-term outcomes.