Editor’s Note:

After the expert recommendation to rename Non-Alcoholic Fatty Liver Disease (NAFLD) to Metabolic Associated Fatty Liver Disease (MAFLD), an international expert group in June 2023 proposed renaming MAFLD to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). The term “steatotic” replaces “fatty,” emphasizing the disease’s close tie to metabolic issues.

This change in terminology reflects the ongoing evolution of clinical concepts in fatty liver disease. At the 2023 American Association for the Study of Liver Diseases (AASLD 2023), Professor Vincent Wai-Sun Wong from the Chinese University of Hong Kong was invited to discuss “Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Global Variances and Therapeutic Approach.” Professor Wong shared in-depth insights into the global differences and therapeutic advancements in MASLD.

Hepatology Digest : MASLD has been a major focus in liver disease recently. Could you discuss the recent global epidemiological changes in this disease?

• Prof. Wong: In just the past year or two, many review studies in the MASLD field have been published, indicating an increase in prevalence. It is estimated that about 30% of the global population now has MASLD, with even higher rates of 50% to 70% among obese individuals or those with type 2 diabetes.

Hepatology Digest : How do Asian patients differ from their European and American counterparts in incidence, treatment, and prognosis?

• Prof. Wong: Previously, MASLD was considered uncommon in Asia. However, recent studies show that its prevalence in Asia is also around 30%, similar to Europe and America. Generally, severe cases are less common in Asia, possibly due to milder metabolic diseases and shorter durations of obesity and liver disease progression. However, this might change over time with shifts in diet, lifestyle, and population aging, potentially altering the epidemiology and clinical characteristics of MASLD in Asia.

Hepatology Digest : Besides lifestyle interventions, what significant advancements have been made in controlling MASLD through surgery and medication?

• Prof. Wong: Lifestyle changes, diet management, and exercise remain the primary treatments for MASLD. For patients who struggle with these changes or have poorly controlled type 2 diabetes, medication can be effective. Although no drugs are currently approved by the FDA or EMA specifically for MASLD, some in clinical trials have shown promise. GLP-1 receptor agonists, like Semaglutide, have been effective in reducing weight and blood sugar and offer cardiovascular protection. Thyroid hormone receptor β (THRβ) agonists show potential in reducing liver fat and improving fibrosis, potentially becoming the first approved drugs for MASLD.

• Advances in MASLD’s surgical treatment have also been made. Studies show weight-loss surgery effectively reduces NAS and improves fibrosis; for severely obese patients, it significantly reduces the risk of liver cirrhosis complications, possibly by over 50%.

Hepatology Digest : How should MASLD generally be managed?

• Prof. Wong: Lifestyle change remains the most crucial aspect of MASLD management, with prevention being ideal. However, some patients cannot comply with lifestyle management or achieve target weights even with proper exercise and diet. In such cases, medication intervention is necessary. Weight-loss surgery may also be considered for severely obese patients.

Hepatology Digest : Considering the latest developments at the conference, what new methods or concepts do you find promising or worth exploring further?

• Prof. Wong: The AASLD conference showcased many new research data on MASLD diagnosis and treatment. The potential emergence of new therapies in the next year or two and their clinical application is very interesting. Some drugs have shown encouraging phase II clinical trial results, improving fibrosis in most patients. We await their phase III clinical performances, which might offer new ways to manage severe liver disease.