Editor’s Note:

The 2023 American Association for the Study of Liver Diseases (AASLD 2023) recently concluded in Boston, USA. metabolic dysfunction-associated steatotic liver disease (MASLD) was a key topic at the conference. In the “Healthy Liver, Healthy Lives” session, experts discussed how to reverse the global MASLD trend and what actions to take to address MASLD management challenges. Dr. Jeffrey V. Lazarus, head of the Health Systems Research Group at ISGlobal in Barcelona, Spain, attended the meeting and gave an interview to “Hepatology Digest” afterward. The interview video and the transcript in both English and Chinese are compiled below.

1. Global Prevalence of MASLD

Hepatology Digest : What is the global prevalence trend of MASLD? Are there specific regions or populations more affected, and why?

• Professor Jeffrey V. Lazarus: Currently, the prevalence of metabolic dysfunction-associated steatohepatitis (MASH) is estimated at a staggering 38% of the adult population globally. There is significant variability in the incidence of MASLD between countries and within different regions of the same country. One of the most severely affected groups is patients with Type II diabetes. It’s estimated that the prevalence among them is more almost double the global rate, exceeding 60%.

2. Current Treatment and Management Strategies for MASLD

Hepatology Digest : What actions have been taken to address MASLD? Are the existing treatment and management approaches effective?

• Professor Jeffrey V. Lazarus: I’d like to break this question into two parts. Globally, we’ve done relatively little for MASH. It’s not considered a public health threat, so it’s not on the global health agenda. In fact, the World Health Organization has never mentioned steatotic liver disease and hepatitis. However, that doesn’t mean nothing is done when a patient is clinically diagnosed.

• Patients with MASLD are usually diagnosed in hepatology or gastroenterology departments, but also sometimes in endocrinology and primary care settings. The current treatment available to them often involves lifestyle changes: more physical activity, a healthier diet, and lower caloric intake. These are the recommendations we can offer to patients, along with treating common comorbidities like diabetes, obesity, and hypertension.

3. Focus of Scientific Research in the Field of MASLD

Hepatology Digest : What are the current research focuses for MASLD? What key scientific questions need further exploration?

• Professor Jeffrey V. Lazarus: Current research focuses on developing and improving non-invasive tests. We hope to replace invasive tests like liver biopsies with serum tests or imaging exams. Since there are no specific medications for steatotic fatty liver inflammation, there’s also significant investment in the treatment field. Some research is also focused on public health issues, different care models, and planning the best stratified management. An exciting new study is focusing on the economic burden, understanding both the direct healthcare costs and the indirect costs of productivity.

4. Future Action Plans to Address MASLD Challenges

Hepatology Digest : What research and action roadmap do we need to better address the challenges of MASLD? How should it be implemented and monitored?

• Professor Jeffrey V. Lazarus: Over the past few months, we published a global research and action agenda in the official journals of EASL, Journal of Hepatology, and AASLD’s Hepatology. Over 350 experts from more than 100 countries, not just liver experts but also health system experts, diabetes specialists, and others, came together for multiple rounds of Delphi studies. We hoped to reach a consensus on the urgent research and action agenda issues that need attention. These issues include treatment and care models, as well as education, awareness, leadership, and other related issues. We’ve established a comprehensive research and action agenda in the fields of MASLD and hepatitis for the first time.