Professor Yang Shufang from Taizhou People’s Hospital Affiliated with Nanjing Medical University shared insights on the current management status of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).
Given that MASLD involves numerous risk factors including obesity, glycemic abnormalities, and metabolic disorders, its treatment requires multidisciplinary collaboration. Core therapeutic strategies focus on reducing body mass index (BMI) and waist circumference, improving insulin resistance (IR), preventing and managing metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM), alleviating metabolic dysfunction-associated steatohepatitis (MASH), and reversing liver fibrosis.
The Guidelines for the Prevention and Treatment of Metabolic Dysfunction-Associated (Non-Alcoholic) Steatotic Liver Disease (2024 Edition) stipulates that all MASLD patients must modify unhealthy lifestyles. Pharmacological interventions are indicated for those with concurrent cardiometabolic risk factors and liver injury, including anti-obesity drugs, lipid-regulating agents, antihypertensives, glucose-lowering medications, and antiplatelet drugs. Additionally, metabolic surgery and liver transplantation can be considered for eligible MASLD patients meeting surgical indications.
Furthermore, weight reduction serves as a critical intervention for overweight/obese MASLD patients. Clinical studies demonstrate that gradual weight loss of 3%–5% within one year reverses hepatic steatosis; 7%–10% weight loss alleviates MASH; over 10% weight loss reverses liver fibrosis; and 15% weight loss even improves T2DM.
Lifestyle modification is paramount, covering dietary regulation, physical activity, and behavioral management:
Dietary Therapy: Low-carbohydrate diets, low-fat diets, intermittent fasting, and Mediterranean diets facilitate weight loss while conferring cardiometabolic and hepatic benefits. To enhance implementation and long-term adherence, clinical dietitians can formulate personalized dietary prescriptions based on patients' comorbidities and food preferences.
Exercise Therapy: Progressive physical activity increases skeletal muscle mass and function, reducing hepatic fat content independent of body weight loss.
Behavioral Therapy: MASLD patients should adopt an energy-negative dietary pattern and avoid unhealthy habits including smoking, alcohol consumption, irregular eating (skipping breakfast, nighttime snacking, rapid eating, sugary soft drinks), staying up late, and sedentary lifestyles.