This protocol addresses metabolic dysfunction-associated steatotic liver disease (MASLD) in adults with overweight or obesity — defined as a body mass index of ≥25 kg/m² in non-Asian adults or ≥23 kg/m² in adults of Asian ethnicity. Elevated BMI is central to disease activity in this population and is the primary therapeutic lever.
Management centres on dietary and behavioural therapy-induced weight loss, including diet-quality improvements and structured physical activity — the complete regimen with full recommendations is in the protocol below.
DOI: 10.1016/j.jhep.2024.04.031
In adults with MASLD, dietary and behavioural therapy-induced weight loss should be recommended to improve liver injury, as assessed histologically or non-invasively (LoE 1, strong recommendation, strong consensus).
In adults with MASLD and overweight, dietary and behavioural therapy-induced weight loss should aim at a sustained reduction of >5% to reduce liver fat, 7-10% to improve liver inflammation, and >10% to improve fibrosis (LoE 2, strong recommendation, strong consensus).
In adults with MASLD, improving diet quality (similar to the Mediterranean dietary pattern), limiting the consumption of ultra-processed food (rich in sugars and saturated fat) and avoiding sugar-sweetened beverages should be recommended to improve histologically or non-invasively assessed liver injury (LoE 2, strong recommendation, strong consensus).
In adults with MASLD, physical activity and exercise should be recommended to reduce steatosis, tailored to the individual's preference and ability (preferably >150 min/week of moderate or 75 min/week of vigorous-intensity physical activity) (LoE 1, strong recommendation, strong consensus).
Overweight: BMI of 25-29.9 kg/m² (non-Asian) or 23-24.9 (Asian). Obesity: >30 kg/m² (non-Asian), >25 kg/m² (Asian).
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