The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) continues to rise globally, driven by the increasing rates of obesity and metabolic syndrome. Epidemiological studies indicate that by 2019, the global and Asian prevalence of MASLD had reached nearly 30% and is steadily climbing. MASLD, along with its associated complications such as cirrhosis and liver cancer, has become a pressing public health issue. At the 2024 Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), Hepatology Digest conducted an exclusive interview with Dr. Vincent Wai-Sun Wong from The Chinese University of Hong Kong. He provided an in-depth analysis of the epidemiological characteristics, risk factors, diagnostic tools, and treatment prospects of MASLD in Asia.Epidemiological Characteristics of MASLD in Asia
Hepatology Digest: Could you elaborate on the epidemiological characteristics of MASLD in Asia? How does it differ from other regions?
Dr. Vincent Wai-Sun Wong: MASLD has become one of the most significant health challenges in China due to its high prevalence. Recent data indicate that approximately 30% of the population in China has fatty liver disease, with most cases strongly associated with obesity and metabolic disorders. This prevalence is comparable to other countries and may be influenced by genetic factors and changing lifestyle habits.
Interestingly, even among non-obese individuals in China, the prevalence of MASLD is relatively high. This is primarily linked to other metabolic conditions, such as diabetes and dyslipidemia, highlighting a unique aspect of MASLD in this region.
Risk Factors in Asian Populations
Hepatology Digest: What are the key risk factors for MASLD in Asian populations? Do these vary across different countries or regions within Asia?
Dr. Vincent Wai-Sun Wong: There is a strong association between MASLD and various metabolic diseases, with diabetes being the most significant risk factor. For example, in a screening study we conducted on type 2 diabetes patients using liver elastography, approximately 70% had elevated CAP values, reflecting increased liver fat content. Furthermore, nearly 20% exhibited abnormal liver stiffness, indicating a higher risk of fibrosis.
In clinical practice, it is common to diagnose one case of fatty liver for every two patients and a case of moderate to severe liver fibrosis for every five to six patients. This underscores the importance of systematic screening.
While the connection between metabolic diseases and MASLD is globally consistent, outcomes may differ regionally. For example, Asian populations, particularly in China, have a higher likelihood of developing kidney disease as a complication of metabolic disorders compared to cardiovascular diseases, which are more prevalent in Western populations. These differences may stem from genetic predispositions and lifestyle variations.
Advancements in Diagnostic Tools
Hepatology Digest: You mentioned the use of specific biomarkers and diagnostic tools for MASLD in Asian populations. Could you share which biomarkers and methods are currently considered the most effective or promising?
Dr. Vincent Wai-Sun Wong: We can divide the discussion into existing biomarkers and those under research.
For existing biomarkers, most guidelines recommend a two-step approach to evaluate liver disease severity. The first step involves the FIB-4 score, a simple method that incorporates age, platelet count, and transaminase levels to preliminarily assess significant fibrosis. If abnormalities are detected, further evaluation with specific biomarkers is required. The choice of tests often depends on the healthcare system’s capabilities and local resources. In China, we frequently use ultrasound-based elastography techniques, such as FibroScan and FibroTouch, which are effective and practical for identifying severe cases requiring specialized care.
However, current biomarkers have limitations, particularly in their positive predictive value. As such, we are actively researching new biomarkers. Proteomics is an emerging focus, with several commercial platforms now available that offer valuable insights. Nonetheless, these technologies require validation in larger cohorts before clinical application.
Management and Treatment Innovations for MASLD
Hepatology Digest: What management and treatment approaches do you consider most effective or innovative for MASLD in Asia?
Dr. Vincent Wai-Sun Wong: Improving lifestyle habits remains the cornerstone of MASLD prevention and treatment. We emphasize dietary adjustments and regular exercise. Additionally, with technological advancements, we are exploring innovative tools such as artificial intelligence and mobile applications to support patients in adopting healthier lifestyles.
That said, some patients struggle with adherence or fail to see significant improvements in weight or liver function despite their efforts. In such cases, pharmacological interventions may be necessary.
Currently, no drugs are approved for MASLD treatment in China. However, in the U.S., the FDA approved Resmetirom this year, a selective thyroid hormone receptor beta (THR-β) agonist that effectively reduces liver inflammation and fibrosis. While the drug is expensive and not yet available in China, its approval offers hope for MASLD treatment.
At this year’s AASLD, positive Phase III trial results for Semaglutide were presented. This GLP-1 receptor agonist not only aids in weight loss and glycemic control but also significantly improves liver inflammation and fibrosis. We expect Semaglutide to gain approval for treating metabolic dysfunction-associated steatohepatitis (MASH) as early as next year.
Looking ahead, GLP-1 receptor agonists are poised to become a primary treatment option for MASH, offering new hope and options for MASLD patients.
Emerging Research Trends at AASLD 2024
Hepatology Digest: Which topics at this year’s AASLD caught your attention? Could you share any notable advancements or trends?
Dr. Vincent Wai-Sun Wong: One of the most exciting areas of progress is drug development for MASH. Beyond Semaglutide, another promising avenue involves fibroblast growth factor 21 (FGF21) analogs. Two FGF21 analogs presented positive Phase IIb results, demonstrating significant improvements in fibrosis and hepatitis.
Additionally, Boston Scientific unveiled new findings on Eflomosfermin, an FGF21 agonist requiring only monthly injections. Its primary endpoints include MASH resolution and fibrosis improvement, with positive outcomes achieved in six-month trials. While it has not yet entered Phase III trials, it is nearing that milestone, making FGF21 analogs a hot topic in current research.
