Evolving models of care in patients with metabolic dysfunction-associated steatotic liver disease, recognising its population burden and the impact of metabolic dysfunction on incident rates of hepatic and extrahepatic outcomes

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with any one of five principal traits of the metabolic syndrome. MASLD is characterised by multimorbidity with liver-related and extrahepatic complications including cardiovascular and cardiac disease, chronic kidney disease and certain extrahepatic cancers. While increasing liver fibrosis severity is well-established as a major contributor to the hepatic complications of MASLD, emerging evidence demonstrates that the severity of associated metabolic dysfunction significantly influences adverse extrahepatic clinical outcomes and all-cause mortality. Changing models of care are needed for patients with MASLD, extending the focus beyond that of liver health and optimising the inherent (heterogeneous) cardiometabolic dysfunction. Such an approach requires multi-stakeholder and community-based engagement with improved identification and diagnosis, and better patient and healthcare provider education that also focuses on type 2 diabetes, hypertension, and obesity, to ameliorate the consequences of this highly prevalent global multisystem disease.