Guideline comparison for fatty liver disease: European (EASL-EASD-EASO) and Asian (APASL) perspectives

INTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) represent an increasing global health challenge for modern medicine. Europe and Asia have responded with region-specific guidelines -respectively, European Association for the Study of the Liver (EASL)-European Association for the Study of Diabetes (EASD)-European Association for the Study of Obesity (EASO) for MASLD and Asian Pacific Association for the Study of the Liver (APASL) for MAFLD- that reflect different epidemiology, clinical priorities and healthcare systems. AREAS COVERED: We compare the two guidelines on the basis of three main points: 1) definitions and diagnostic strategies, 2) treatment and in particular lifestyle and pharmacological options, and 3) surveillance approaches. EXPERT OPINION: Both guidelines agree on the central role of lifestyle management and early diagnosis. However, there are several differences in diagnosis, pharmacotherapy, and surveillance. The European approach supports targeted fibrosis assessment using fibrosis-4 and transient elastography. On the other hand, the Asian-Pacific framework provides broader coverage, including special populations. What our analysis suggests is a harmonization, to be reached via global consensus, that balances precision medicine with inclusivity and that supports collaborative, cross-regional research that focuses on closing the gaps of current knowledge.