Managing MASLD Through Preventive Hepatology: Integrating Policy Reform, Public Health and Personalised Care

Metabolic dysfunction-associated steatotic liver disease (MASLD) is growing in prevalence around the world, with a current global prevalence rate of 38%. Although MASLD serves as an umberlla term, its subtype of metabolic dysfunction associated steatohepatitis (MASH) with a prevalence of 5-7%, can lead to adverse liver outcomes including cirrhosis and liver mortality. However, prevalence rates for MASLD/MASH vary by country and region of the world. With the increasing rates of type 2 diabetes and obesity, MASLD/MASH is increasing and is currently among the top causes of hepatocellular carcinoma and an indication for liver transplantation in the United States. Therefore, the care model is shifting to prevention given this large clinical, economic and humanistic burden of this liver disease. As in other noncommunicable diseases, interventional priorities for policymakers should be focused on building infrastructure that supports physical activity and healthy food choices as well as access to approved treatments for MASLD. At the same time, identifying individuals at risk for adverse outcomes using non-invasive tests and developing individual care plans that address the needs of each patient with MASLD, including their mental and physical health, should be a focus for healthcare providers. Furthermore, raising awareness among patients, the public and healthcare providers continues to be a crucial need. This report will provide recommendations for policymakers to provide the needed interventions to reverse the current trajectory of this liver disease.