Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of obesity and metabolic syndrome. It is mainly caused by insulin resistance. With the increased risk of visceral obesity in South Asians, the prevalence of MASLD is on the rise. The morbidity associated with MASLD and its complications, including hepatocellular carcinoma is projected to increase in this South Asian population. Methods: In this narrative review we explore the diagnosis and management of MASLD in the South Asian population. We summarize the findings from the recent literature on the diagnostic methods and management options for MASLD in this population. Results: Through our search we found no specific guidelines for the diagnosis and management of MASLD in the South Asian population. The existing general guidelines may not be applied to South Asian populations due to the differences in phenotype, genotype, social and cultural aspects. South Asian countries also have limited resources with the non-availability of newer pharmacotherapeutic agents. Conclusion: The goal of this review is to guide obesity physicians and primary care providers to have a stepwise approach to treat patients at risk for MASLD with a main focus on interdisciplinary management most applicable to South Asian patients. More research is needed to formulate guidelines and algorithm that are specific for the South Asian population.

Keywords

• FIB-4
• Lean obesity
• Liver fibrosis
• Metabolic dysfunction-associated steatotic liver disease
• Sarcopenia