The frontline of metabolic dysfunction–associated steatotic liver disease: More to be discovered

Sep 29, 2026

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Editorial overview of metabolic dysfunction–associated steatotic liver disease (MASLD) describing its rapid global rise and clinical implications. Summarizes a review that integrates MASLD/MASH pathogenesis, diagnostic algorithms, natural history prediction, and therapeutic strategies, emphasizing multiple-hit mechanisms and emerging biomarkers. Highlights noninvasive fibrosis scoring and imaging approaches to reduce biopsy reliance, and discusses lifestyle measures plus evolving pharmacologic and surgical options.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Editorial overview

MASLD epidemiology and unmet needs

Pathogenesis and diagnostic frameworks

Noninvasive assessment tools

Lifestyle, pharmacologic, and surgical management

J Chin MedAssoc Editorial The frontline of metabolic dysfunction–associated steatotic liver disease: More to be discovered Chun-Ting Hoa, Wei-Yu Kaob,c,d,e,f, Chien-Wei Sua,g,h,* aDivision of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC; cDepartment of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; dGraduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan, ROC; eTaipei Cancer Center, Taipei Medical University, Taipei, Taiwan, ROC; fTMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan, ROC; gSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; hInstitute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Metabolic dysfunction–associated steatotic liver disease (MASLD) has emerged as the most prevalent cause of chronic liver disease worldwide, driven by the global rise in obesity, type 2 diabetes mellitus, and metabolic syndrome. It currently affects approximately 38% of the adult population globally, with nearly a 50% increase in prevalence over the past decade.1 This upward trend is projected to persist in the coming years.2 This growing burden of MASLD highlights the urgent need for greater clinical awareness and intensified research efforts aimed at developing precision diagnostics and targeted therapeutic strategies.3 In their comprehensive review, Yeh et al4 summarize the multifaceted pathogenesis, diagnostic algorithms, natural history prediction models, and promising therapeutic strategies for MASLD, metabolic dysfunction–associated steatohepatitis (MASH), and MASLD-related hepatocellular carcinoma (HCC) . They elucidate the complex pathophysiology of MASLD, which is driven by a multiple-hit hypothesis involving metabolic, genetic, and environmental factors. The key mechanisms, including insulin resistance, oxidative stress, gut–liver axis dysregulation, and genetic/epigenetic modifiers, contribute to the progression from simple steatosis to inflammation, fibrosis, and ultimately carcinogenesis.5,6 The review highlights novel mechanistic insights, such as m6A RNA methylation promoting lipogenic reprogramming, and gut microbial metabolites modulating hepatic immune surveillance via CXCL16-NKT cell axis, both of which offer promising therapeutic opportunities. By integrating single-cell transcriptomics, polygenic risk modeling, and liquid-biopsy biomarker development,7 the authors present a comprehensive framework to characterize MASLD heterogeneity and identify high-risk patients before irreversible liver damage occurs. *Address correspondence. Dr. Chien-Wei Su, Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: cwsu2@vghtpe.gov.tw](ROC. E-mail address: cwsu2@vghtpe.gov.tw) (C.-W. Su). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2025) 88: 660-661. Received July 2, 2025; accepted July, 3, 2025 doi: 10. 1097/JCMA.0000000000001266 Copyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) A key strength of this review is its clear, side-by-side comparison of noninvasive scoring systems (such as fibrosis-4 index [FIB-4], aspartate transaminase [AST] to platelet ratio index [APRI], fibroScan-AST Score [FAST], and enhanced liver fibro

FAQs

What is metabolic dysfunction–associated steatotic liver disease (MASLD) and why is it important?

MASLD is a common cause of chronic liver disease driven by increasing obesity and metabolic disorders. The editorial emphasizes its growing prevalence and the need for better clinical awareness and research.

How do the reviewed strategies address diagnosis and risk prediction?

The editorial describes diagnostic algorithms, natural history prediction models, and approaches that integrate single-cell transcriptomics, polygenic risk modeling, and liquid-biopsy biomarkers to identify high-risk patients.

What treatment options does the editorial highlight?

Lifestyle modification focused on weight reduction is presented as foundational. It also covers emerging pharmacologic therapies with clinical trial data and notes bariatric surgery as a therapeutic option in selected patients.

Sep 29, 2026

Uploaded by Himbo