Evidence‐Based Clinical Practice Guidelines for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) 2026

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver disease worldwide, with an increasing number of patients progressing to cirrhosis and hepatocellular carcinoma (HCC). Early identification of individuals at high risk for advanced fibrosis is essential for preventing liver-related events and improving long-term outcomes. This guideline summarizes current evidence and provides practical recommendations for the diagnosis, risk stratification, and management of MASLD in clinical practice. These recommendations were developed through systematic evaluation of the literature and expert consensus. Diagnostic approaches, including noninvasive fibrosis assessment tools, imaging, biochemical testing, and indications for referral to gastroenterology/hepatology specialists, were reviewed. Advanced fibrosis is the major determinant of liver-related morbidity and mortality in MASLD. The Fibrosis-4 (FIB-4) index is a widely accessible and reliable first-line noninvasive tool for fibrosis risk stratification. Patients with elevated FIB-4 values or clinical features suggestive of progressive liver injury should undergo secondary assessment with elastography and be referred to a specialist when appropriate. Liver biopsy is not routinely required for the diagnosis of MASLD but remains essential for establishing a definitive diagnosis of at-risk metabolic dysfunction-associated steatohepatitis (MASH), assessing inflammatory activity, resolving discrepancies between noninvasive tests, and differentiating MASLD from other chronic liver diseases. Lifestyle modification remains the foundation of management, with pharmacological therapy considered for patients with a high likelihood of at-risk MASH. MASLD represents a heterogeneous disease spectrum in which advanced fibrosis is the key prognostic factor. These guideline recommendations aim to standardize clinical practice and support evidence-based management of MASLD in Japan.

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Journal
Hepatology Research
Published
2026-05-12
DOI
https://doi.org/10.1111/hepr.70188
Primary Topic
Liver Disease Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
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article

Evidence‐Based Clinical Practice Guidelines for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) 2026

Yasuto Takeuchi, Takashi Kobayashi, Akira Uchiyama, Kazuyoshi Kon et al.
Hepatology Research
Liver Disease Diagnosis and Treatment
article

Evidence‐Based Clinical Practice Guidelines for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) 2026

Yasuto Takeuchi, Takashi Kobayashi, Akira Uchiyama, Kazuyoshi Kon, Ryuta Shigefuku, Takao Itoi, Dan Nakano, Kenichi Ikejima, Nobuharu Tamaki, Michihiro Iwaki, Masato Yoneda, Susumu Eguchi, Keisuke Kakisaka, Masataka Seike, Tetsuo Takehara, Motoyuki Otsuka, Yuya Seko, Kazuo Notsumata, Hajime Isomoto, Tomomi Kogiso, Sadatsugu Sakane, Sumio Watanabe, Takumi Kawaguchi, Yoshiyuki Takei, Yoshifumi Takeyama, Kaoru Shibayama, Hidekatsu Kuroda, Hirokazu Takahashi, Hirohito Sone, Naoto Fujiwara, Kanji Yamaguchi, Takuya Adachi, Hiroshi Yotsuyanagi, Hayato Hikita, Miwa Kawanaka, Norio Akuta, Masahiro Koseki, Noriyo Urata, Hayato Nakagawa, Tsubasa Tsutsumi, Hideki Fujii, Atsushi Takai, Satoshi Mochida, Yasuhiro Matsubayashi, Hisamitsu Miyaaki
article en

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver disease worldwide, with an increasing number of patients progressing to cirrhosis and hepatocellular carcinoma (HCC). Early identification of individuals at high risk for advanced fibrosis is essential for preventing liver-related events and improving long-term outcomes. This guideline summarizes current evidence and provides practical recommendations for the diagnosis, risk stratification, and management of MASLD in clinical practice. These recommendations were developed through systematic evaluation of the literature and expert consensus. Diagnostic approaches, including noninvasive fibrosis assessment tools, imaging, biochemical testing, and indications for referral to gastroenterology/hepatology specialists, were reviewed. Advanced fibrosis is the major determinant of liver-related morbidity and mortality in MASLD. The Fibrosis-4 (FIB-4) index is a widely accessible and reliable first-line noninvasive tool for fibrosis risk stratification. Patients with elevated FIB-4 values or clinical features suggestive of progressive liver injury should undergo secondary assessment with elastography and be referred to a specialist when appropriate. Liver biopsy is not routinely required for the diagnosis of MASLD but remains essential for establishing a definitive diagnosis of at-risk metabolic dysfunction-associated steatohepatitis (MASH), assessing inflammatory activity, resolving discrepancies between noninvasive tests, and differentiating MASLD from other chronic liver diseases. Lifestyle modification remains the foundation of management, with pharmacological therapy considered for patients with a high likelihood of at-risk MASH. MASLD represents a heterogeneous disease spectrum in which advanced fibrosis is the key prognostic factor. These guideline recommendations aim to standardize clinical practice and support evidence-based management of MASLD in Japan.

Hepatology Research
The Japanese Society of Gastroenterological Surgery (JP), Japan Science Society (JP), The Physical Society of Japan (JP), Tokyo Women's Medical University (JP), Toranomon Hospital (JP)
Good health and well-being
Openalex Percentile: Top 5%
Liver Disease Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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