Page 29 - Ebook-Book JCMS 2025

Global and National Perspectives on Metabolic Dysfunction-Associated Steatotic
Liver Disease: From Epidemiology to Clinical Management
Phunchai Charatcharoenwitthaya, M.D.
Faculty of Medicine, Siriraj Hospital, Mahidol University

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as NAFLD
or MAFLD, is now recognized as the most prevalent chronic liver disease globally, driven by rising rates
of obesity, metabolic syndrome, and type 2 diabetes. Research efforts from Thailand, in collaboration with
regional and global partners, have contributed significantly to the understanding of MASLD across its full
clinical spectrum—from epidemiology and diagnosis to prognosis and management.
National epidemiologic studies in Thailand have characterized the high prevalence of MASLD and
its distinct clinical phenotypes, including lean and diabetes-associated MASLD, both of which are
associated with increased mortality risk. Large-scale cohort analyses have identified metabolic phenotype,
alcohol consumption, and sarcopenia as critical modifiers of prognosis, while also highlighting the
limitations of traditional risk indicators such as body mass index. These findings have informed risk
stratification models that integrate demographic, biochemical, and lifestyle variables.
In collaboration with regional and global research networks, multicenter studies and systematic
reviews have expanded understanding of MASLD pathophysiology, fibrosis progression, and extrahepatic
complications, including fatty pancreas, cardiovascular disease, and chronic kidney disease. A particular
focus has been placed on improving early detection of advanced fibrosis using accessible and cost-
effective tools. This includes the development of novel non-invasive risk scores and the application of
machine learning algorithms—validated across Asian populations—to outperform conventional fibrosis
scoring systems.
Clinical research efforts have addressed lifestyle interventions, nutritional impacts, and novel
therapeutic approaches, such as pharmacological treatments (e.g. licogliflozin) and exercise regimens,
demonstrating their potential to mitigate disease progression. Additionally, research on health behaviors,
such as smoking, alcohol consumption, and caffeine intake, has clarified modifiable lifestyle factors linked
to disease severity. Economic evaluations support the value of early screening and lifestyle intervention
programs in high-risk groups, particularly in resource-constrained settings.
On a global scale, participation in consensus-building initiatives—including the Delphi process
for MASLD nomenclature and ICD-11 coding reform—has helped unify diagnostic frameworks and reduce
stigma associated with disease terminology. These initiatives underscore a commitment to harmonizing
global diagnostic frameworks while advocating for stigma-free terminology and improved disease
recognition.
Overall, this integrated body of work contributes a nationally relevant and globally informed
perspective on MASLD, addressing its epidemiologic trends, clinical complexity, and implications for
prevention, diagnosis, and care. It serves as a foundation for shaping future guidelines, informing policy,
and improving patient outcomes across diverse healthcare systems.
Harmony in health: Innovation for Sustainable Medicine 27