Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity: A joint position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Hepatology (SBH), and Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso)

Abstract

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.

Response to the letter to the editor Fibrosis or steatosis: which is the best screening target? Comment on the Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity

“…The letter by Mateus Severo raises important questions regarding the screening and diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity. The points presented in the letter have been discussed in detail by the authors during the Brazilian Evidence-Based guideline elaboration ( 1 ) and deserves further clarification.…”

Is Steatotic Liver Disease Related to Poor Outcome in COVID-19-Hospitalized Patients?

“…Steatotic liver disease (SLD), an overarching umbrella term introduced in 2023 by a multinational consensus to encompass the various etiologies of steatosis [7,8], is currently the most common cause of chronic liver disease worldwide, with prevalence ranging from 13.5% in Africa to 31.8% in the Middle East and showing a substantial increase over the last decade in South America (30%) [9]. The main risk factors are obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome.…”

Fibrosis or steatosis: which is the best screening target? Comment on the Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity

“…Screening strategies are interesting for highly prevalent diseases with a detectable preclinical phase, beneficial therapeutic options, and accurate and cost-efficient screening tests. However, the screening strategy proposed in the "Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity" is quite problematic, as it focuses primarily on detecting steatosis ( 1 ).…”

“…The projected prevalence rates of overweight and obesity in Brazil by 2030 are 68.1% and 29.6%, respectively ( 5 ). Thus, the screening strategy proposed in the Brazilian guideline ( 1 ) lacks accuracy and economic viability and is unable to serve the Brazilian population, deserving a review.…”