Metabolic dysfunction-associated steatotic liver disease (MASLD) remains largely underdiagnosed and asymptomatic, creating major opportunities for pharmacists to drive early identification, lifestyle intervention, and metabolic risk management.
In an interview with Pharmacy Times, Jiyeon Oh, MD, first author and staff at the Department of Medicine at Kyung Hee University College of Medicine in Seoul, South Korea; Min Seo Kim, MD, MS, corresponding author and staff at the Cardiovascular Disease Initiative, Broad Institute; and Dong Keon Yon, MD, PhD, corresponding author and assistant professor in the department of pediatrics at Kyung Hee University, discussed the clinical implications of metabolic dysfunction-associated steatotic liver disease (MASLD), including gaps in detection, treatment limitations, and opportunities for pharmacist involvement.1
The authors emphasized that stable disability-adjusted life year (DALY) rates found in a study they authored likely reflect a large and growing pool of patients with early, asymptomatic disease who have not progressed to cirrhosis or hepatocellular carcinoma. This “at-risk reservoir” underscores the importance of early intervention, as most patients remain undiagnosed until advanced disease develops, limiting opportunities for prevention.1
They identified major gaps in screening and diagnosis, particularly due to the asymptomatic nature of early MASLD and underdiagnosis in lower-resource settings. Limited diagnostic infrastructure often results in identification only after complications emerge. Accordingly, the authors highlighted a critical opportunity for pharmacists to support earlier identification and prevention. They can help identify at-risk patients with diabetes, obesity, dyslipidemia, or hypertension and reinforce the link between metabolic health and liver disease. They also play a role in counseling, adherence support, and education around emerging therapies targeting metabolic dysfunction-associated steatohepatitis (MASH).1
Pharmacy Times: The burden appears concentrated in certain regions, particularly the Middle East and North Africa. What factors are contributing to these geographic differences?
Jiyeon Oh, MD; Min Seo Kim, MD, MS; and Dong Keon Yon, MD, PhD: The paper points to several factors. First, metabolic risk factor burden is disproportionately high in the region: North Africa and the Middle East had both the highest MASLD prevalence and the highest T2D global burden of disease (GBD), and high BMI [body mass index] contributed the largest attributable DALY rate for MASLD of any GBD region. Second, the region shows disproportionately high prevalence relative to its social deprivation index level, meaning that socioeconomic development alone does not explain the pattern and that regional dietary, cultural, or health-system factors appear to be independently contributing.
Interestingly, despite the highest prevalence rates, the DALY rates in North Africa and the Middle East were relatively modest. The paper suggests this may reflect the comparatively recent rise in MASLD prevalence in the region, meaning insufficient time has elapsed for widespread progression to cirrhosis and liver cancer. If so, the region may be facing a substantial future wave of advanced disease unless prevention and early management are scaled urgently.
Pharmacy Times: Given that many patients are in younger adult age groups, what does this mean for long-term disease risk and health system burden?
Oh, Kim, and Yon: Younger patients with MASLD have more decades ahead during which the disease can progress to cirrhosis, hepatocellular carcinoma, or complications from associated conditions such as cardiovascular disease and chronic kidney disease. The health system burden is therefore not just about managing current disease but about preventing a future wave of advanced liver disease, transplantation needs, and liver cancer in a cohort that is currently largely asymptomatic and often not engaged with specialist care. Therefore, the paper calls for early, population-level interventions, including awareness and lifestyle support, that are most impactful precisely in younger populations before irreversible fibrosis develops.
Pharmacy Times: From a clinical standpoint, where are the biggest gaps today in screening, diagnosis, or management of MASLD?
Oh, Kim, and Yon: First, the majority of patients with MASLD are asymptomatic, which creates a fundamental surveillance challenge—patients do not present because they feel well, and clinicians may not screen systematically in the absence of symptoms or referral prompts.
Second, there is the issue of underdiagnosis in lower-resource settings. Lower sociodevelopment scores and health care access index are associated with higher age-standardized DALY rates, and this may partly reflect underdiagnosis of mild, precirrhotic MASLD in settings with limited diagnostic infrastructure—meaning cases are only captured when complications have already developed.
Third, on the treatment side, the paper acknowledges that the pharmacotherapy landscape is still nascent: resmetirom (Rezdiffra; Madrigal Pharmaceuticals) and semaglutide (Wegovy; Novo Nordisk) are currently the only FDA-approved therapies for MASH, and translating emerging evidence into national care pathways and guidelines remains an ongoing challenge, particularly in lower-income settings.
Pharmacy Times: For pharmacists, what are the most actionable opportunities to help identify at-risk patients and support prevention or early intervention?
Oh, Kim, and Yon: First, awareness and education: pharmacists are often the most accessible health care professionals, particularly for patients managing T2D, obesity, dyslipidemia, or hypertension, all of which are closely associated with MASLD. Public and clinician awareness of MASLD is still low; pharmacists can help close that gap through opportunistic counseling during medication dispensing and chronic disease management consultations.
Second, supporting pharmacological management: resmetirom and semaglutide are currently the only approved pharmacotherapies for MASH, and other antidiabetic drugs show promise more broadly. Pharmacists play a critical role in medication counseling, adherence support, and monitoring for patients on these agents and in educating patients on the connection between their metabolic therapies and liver health.
Third, lifestyle reinforcement: prior studies indicated that losing more than 5% to 7% of body weight reduces liver fat, and exceeding 10% weight loss can even reduce fibrosis. Pharmacists can actively support behavioral change conversations around diet and physical activity as part of routine interactions.
Pharmacy Times: Is there anything else that you would like to add, or anything that I missed?
Oh, Kim, and Yon: MASLD affects 16.1% of the global population—comparable in scale to many conditions that are explicit targets in global health strategies—yet it is not currently included in global noncommunicable disease action plans. This paper makes a direct call for this to change, arguing that the burden estimates from this study provide the evidence base for policy makers to set specific targets and align MASLD prevention, screening, and treatment with broader metabolic initiatives.
