{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:25:06Z","timestamp":1791635106956,"version":"4.3.4"},"reference-count":101,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100011221","name":"Heersink School of Medicine, University of Alabama at Birmingham","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011221","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The clinical management of metabolic dysfunction\u2010associated steatotic liver disease (MASLD) and metabolic dysfunction\u2010associated steatohepatitis (MASH) is undergoing rapid evolution, driven by advances in noninvasive diagnostics and the recent approval of liver\u2010directed therapies. Multiple professional societies have issued guidelines and clinical care pathways to address screening, risk stratification, treatment initiation, and monitoring; however, substantial heterogeneity exists across these documents. In this review, we systematically compare major contemporary guidelines from hepatology, gastroenterology, endocrinology, and diabetes societies, highlighting areas of consensus as well as key differences in target populations for screening, noninvasive test thresholds, treatment eligibility criteria, and monitoring strategies. We analyse the methodological underpinnings of these recommendations, emphasising important limitations related to reliance on trial\u2010derived populations, the absence of head\u2010to\u2010head comparisons, and the use of noninvasive test cutoffs extrapolated from highly selected randomised controlled trials. We also discuss how subjective interpretation of emerging evidence, variable consideration of cardiometabolic comorbidities, and limited integration of cost and access considerations contribute to divergent recommendations. Finally, we propose a framework for improving future guidelines, including greater transparency regarding evidence limitations, adoption of prevalence\u2010 and outcome\u2010informed thresholds, clearer guidance on therapy sequencing and combination strategies, and a more holistic approach that aligns liver\u2010specific outcomes with broader cardiometabolic risk reduction. As the therapeutic landscape continues to expand, more adaptive and objective guideline frameworks will be essential to optimise real\u2010world implementation and equity of care.<\/jats:p>","DOI":"10.1111\/dom.70553","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:36:34Z","timestamp":1773390994000},"page":"63-80","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Metabolic liver disease: A summary of major guidelines and identifying opportunities to improve future guidelines"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5570-4396","authenticated-orcid":false,"given":"Fernando","family":"Bril","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"UAB Comprehensive Diabetes Center  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/HC9.0000000000000704","article-title":"Awareness of metabolic dysfunction\u2010associated steatotic liver disease (MASLD) in 4 major cities in the United States","volume":"9","author":"Lazarus JV","year":"2025","journal-title":"Hepatol Commun"},{"key":"e_1_2_15_3_1","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.eprac.2022.03.010","article-title":"American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and Management of Nonalcoholic Fatty Liver Disease in primary care and endocrinology clinical settings: Co\u2010sponsored by the American Association for the Study of Liver Diseases (AASLD)","volume":"28","author":"Cusi K","year":"2022","journal-title":"Endocr Pract"},{"key":"e_1_2_15_4_1","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella ME","year":"2023","journal-title":"Hepatology"},{"key":"e_1_2_15_5_1","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1007\/s00125-024-06196-3","article-title":"EASL\u2010EASD\u2010EASO clinical practice guidelines on the management of metabolic dysfunction\u2010associated steatotic liver disease (MASLD): executive summary","volume":"67","author":"European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity","year":"2024","journal-title":"Diabetologia"},{"key":"e_1_2_15_6_1","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2337\/dci24-0094","article-title":"Metabolic dysfunction\u2010associated Steatotic liver disease (MASLD) in people with diabetes: the\u00a0need for screening and early intervention. 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