In adults with metabolic dysfunction-associated steatotic liver disease (MASLD) and a BMI of ≥25 kg/m² (or ≥23 kg/m² in those of Asian ethnicity), sustained weight reduction is central to improving liver outcomes. When first-line dietary and behavioural therapy does not reach the weight-loss thresholds shown to benefit the liver, a structured next-line approach is indicated.
MASLD in a patient with overweight (BMI 25–29.9 kg/m² in non-Asians; 23–24.9 kg/m² in Asians) or obesity (BMI ≥30 kg/m² in non-Asians; ≥25 kg/m² in Asians). Body weight category directly influences liver-related outcomes in this population.
First-line management — dietary and behavioural therapy-induced weight loss, a Mediterranean-style diet, limiting ultra-processed foods and sugar-sweetened beverages, structured physical activity (>150 min/week moderate or >75 min/week vigorous intensity), and discouraging alcohol — did not achieve the required sustained weight reductions: >5% to reduce liver fat, 7–10% to improve liver inflammation, or >10% to improve fibrosis.
In adults with MASLD, lifestyle modification - including weight loss, dietary changes, physical exercise and discouraging alcohol consumption - as well as optimal management of comorbidities - including use of incretin-based therapies (e.g. semaglutide, tirzepatide) for T2D or obesity, if indicated - is advised.
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).
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).
DOI: 10.1016/j.jhep.2024.04.031 View source ↗