Providing holistic care for patients with metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis: Key aspects of clinical assessment and how to develop individualised care plans for surveillance and interventions.

Metabolic dysfunction-associated steatotic liver disease (MASLD), characterised by hepatic steatosis and metabolic dysfunction (i.e., obesity, type 2 diabetes, dyslipidaemia, and hypertension), is affecting over 30% of the adult population worldwide. It can progress to metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis, cirrhosis and even hepatocellular carcinoma. However, most patients with non-cirrhotic MASLD die from extrahepatic causes, particularly cardiovascular disease and non-hepatic cancers, underscoring the need for a holistic approach to surveillance and treatment. Emerging research on MASLD has revealed a substantial heterogeneity in the MASLD population, driven by sex-specific factors, genetic susceptibility, cardiometabolic risk profile, lifestyle and socio-economic determinants, highlighting the necessity of individualised and holistic management of MASLD patients. Although lifestyle intervention remains the cornerstone of MASLD, the pharmacotherapeutic landscape is rapidly evolving, with resmetirom and semaglutide now approved for non-cirrhotic MASH with moderate-to-advanced fibrosis. In addition, metabolic/bariatric surgery has proven to be a highly effective option for patients with MASH. Given its close association with cardiometabolic and malignant comorbidities, MASLD requires individualised, holistic management integrating hepatic and extrahepatic risks. Multiprofessional care, involving among others behavioural therapists, dieticians and physiotherapists, may improve outcomes of lifestyle interventions, particularly in high-risk settings. A stepwise and integrated care model combining early case-finding, risk stratification, and tailored lifestyle and pharmacological interventions is essential to address both hepatic and extrahepatic complications. This review summarises the current understanding of MASLD heterogeneity, clinical assessment, and therapeutic advances, and outlines principles for individualised and coordinated care.