MASLD — guidelines registry¶
A catalogue of clinical practice guidelines, guidance documents, consensus statements and position papers worldwide. The synthesis of what they recommend, and where they conflict, is in wiki/guidelines.md; this file records the documents.
Every PMID was verified against a live PubMed E-utilities query on 2026-09-02; the two non-PubMed entries were retrieved directly from their publishers on the same date.
Vocabulary column. Documents are written in three incompatible vocabularies — NAFLD/NASH, MAFLD, and MASLD/MASH — and the definitions are not interchangeable (see wiki/nomenclature-and-definitions.md). The column records what each document uses, because it changes the population the recommendation applies to.
Master table¶
| Body | Year | Region | Vocab | Scope | Citation / identifier | Status |
|---|---|---|---|---|---|---|
| AASLD, EASL, ALEH (multisociety Delphi) | 2023 | international | SLD/MASLD | Nomenclature and definitions | Rinella ME, et al. Hepatology. 2023;78(6):1966-1986. PMID 37363821 | current |
| — same statement, J Hepatol co-publication | 2023 | international | SLD/MASLD | Nomenclature | J Hepatol. 2023;79(6):1542-1556. PMID 37364790 | current |
| — same statement, Ann Hepatol co-publication | 2024 | international | SLD/MASLD | Nomenclature | Ann Hepatol. 2024;29(1):101133. PMID 37364816 | current |
| AASLD | 2023 | USA | NAFLD | Full clinical assessment and management | Rinella ME, et al. Hepatology. 2023;77(5):1797-1835. PMID 36727674 | current, read with PMID 38445559 |
| AASLD (nomenclature companion) | 2024 | USA | MASLD | How to read the 2023 guidance under the new terms | Kanwal F, et al. Hepatology. 2024;79(5):1212-1219. PMID 38445559 | current |
| AASLD (semaglutide update) | 2026 (Nov 2025) | USA | MASLD/MASH | Patient selection, monitoring and safety for semaglutide | Bansal MB, et al. Hepatology. 2026;83(5):1326-1340. PMID 41201884 | current |
| AASLD | 2018 | USA | NAFLD | Diagnosis and management | Chalasani N, et al. Hepatology. 2018;67(1):328-357. PMID 28714183 | superseded by → PMID 36727674 |
| EASL–EASD–EASO | 2024 | Europe | MASLD | Full clinical practice guideline | J Hepatol. 2024;81(3):492-542. PMID 38851997 | current |
| — executive summary | 2024 | Europe | MASLD | Summary | Diabetologia. 2024;67(11):2375-2392. PMID 38869512 | current |
| — Obes Facts co-publication | 2024 | Europe | MASLD | Full guideline | Obes Facts. 2024;17(4):374-444. PMID 38852583 | current |
| EASL–EASD–EASO | 2016 | Europe | NAFLD | Full guideline | J Hepatol. 2016;64(6):1388-402. PMID 27062661 | superseded by → PMID 38851997 |
| — Diabetologia co-publication | 2016 | Europe | NAFLD | Full guideline | Diabetologia. 2016;59(6):1121-40. PMID 27053230 | superseded by → PMID 38869512 |
| EASL | 2021 | Europe | cross-aetiology | Non-invasive tests for severity and prognosis | J Hepatol. 2021;75(3):659-689. PMID 34166721 | current |
| APASL | 2025 | Asia-Pacific | MAFLD | Full clinical practice guideline | Eslam M, et al. Hepatol Int. 2025;19(2):261-301. PMID 40016576 | current |
| APASL | 2020 | Asia-Pacific | MAFLD | Full clinical practice guideline (indexed in PubMed as an editorial) | Eslam M, et al. Hepatol Int. 2020;14(6):889-919. PMID 33006093 | superseded by → PMID 40016576 |
| ALEH Latin American working group | 2025 | Latin America | MASLD | Updated management recommendations | Diaz LA, et al. Ann Hepatol. 2025;30(2):101903. PMID 40089151 | current |
| Japan Society of Gastroenterology / JSH | 2026 | Japan | MASLD | Evidence-based clinical practice guideline | Akuta N, et al. J Gastroenterol. 2026;61(6):693-710. PMID 42120590 | current |
| Japan Society of Gastroenterology / JSH | 2021 | Japan | NAFLD/NASH | Evidence-based clinical practice guideline 2020 | Tokushige K, et al. J Gastroenterol. 2021;56(11):951-963. PMID 34533632 | superseded by → PMID 42120590 |
| Chinese national guideline | 2024 | China | MAFLD | Prevention and treatment (version 2024) | Fan JG, et al. J Clin Transl Hepatol. 2024;12(11):955-974. PMID 39544247 | current |
| Spanish multidisciplinary group | 2025 | Spain | metabolic hepatic steatosis | Full clinical practice guideline (Delphi) | Romero-Gómez M, et al. Gastroenterol Hepatol. 2025;48(8):502442. PMID 40221023 | current |
| Spanish consensus document | 2018 | Spain | NAFLD | Management | Aller R, et al. Gastroenterol Hepatol. 2018;41(5):328-349. PMID 29631866 | superseded in practice by → PMID 40221023 |
| NICE | current (retrieved 2026-09-02) | UK | MASLD | Assessment and management | NICE guideline NG49, "Metabolic dysfunction-associated steatotic liver disease (MASLD): assessment and management", https://www.nice.org.uk/guidance/ng49, accessed 2026-09-02 | current |
| ADA | 2025 | USA (diabetes) | MASLD | Screening and early intervention in diabetes | Cusi K, et al. Diabetes Care. 2025;48(7):1057-1082. PMID 40434108 | current |
| AACE, co-sponsored by AASLD | 2022 | USA (primary care/endocrinology) | NAFLD | Diagnosis and management in primary care and endocrinology | Cusi K, et al. Endocr Pract. 2022;28(5):528-562. PMID 35569886 | current |
| AGA | 2021 | USA | NAFLD | Clinical Care Pathway for risk stratification | Kanwal F, et al. Gastroenterology. 2021;161(5):1657-1669. PMID 34602251 | current |
| AGA Clinical Practice Update | 2023 | USA | NAFLD | Non-invasive biomarkers | Wattacheril JJ, et al. Gastroenterology. 2023;165(4):1080-1088. PMID 37542503 | current |
| AGA Clinical Practice Update | 2021 | USA | NAFLD | Lifestyle modification for weight loss | Younossi ZM, et al. Gastroenterology. 2021;160(3):912-918. PMID 33307021 | current |
| AGA Clinical Practice Update | 2022 | USA | NAFLD | Lean individuals | Long MT, et al. Gastroenterology. 2022;163(3):764-774.e1. PMID 35842345 | current |
| Global NASH Council / international Delphi | 2025 | international | MASLD | Consensus across 61 guideline documents (2018–Jan 2025) | Younossi ZM, et al. Gastroenterology. 2025;169(5):1017-1032.e2. PMID 40222485 | current |
| Global NASH Council (update) | 2026 | international | MASLD | Risk stratification, treatment initiation, response monitoring | Younossi ZM, et al. Clin Gastroenterol Hepatol. 2026;24(9):2333-2347. PMID 41950980 | current |
| EASL holistic guidance | 2026 | Europe | SLD/MASLD | Multidisciplinary screening and patient-management trajectory | Brouwer WP, et al. JHEP Rep. 2026;8(9):101798. PMID 42617506 | current |
| Expert panel, alcohol-related liver disease | 2025 | international | MetALD | Position statement on MetALD | Arab JP, et al. J Hepatol. 2025;82(4):744-756. PMID 39608457 | current |
| Expert panel (resmetirom) | 2024 | USA | MASH | Initiating and monitoring resmetirom | Noureddin M, et al. Clin Gastroenterol Hepatol. 2024;22(12):2367-2377. PMID 39038768 | current |
| AHA | 2022 | USA (cardiology) | NAFLD | Scientific statement on cardiovascular risk | Duell PB, et al. Arterioscler Thromb Vasc Biol. 2022;42(6):e168-e185. PMID 35418240 | current |
| AHA/ACC/ADA/ASN | 2026 | USA | CKM syndrome | Cardiovascular-kidney-metabolic syndrome guideline (MASLD as a component) | Ndumele CE, et al. J Am Coll Cardiol. 2026;87(22S):e1889-e2007. PMID 42265997 | current |
| International multidisciplinary panel | 2023 | international | MAFLD | MAFLD and cardiovascular risk | Zhou XD, et al. Hepatol Int. 2023;17(4):773-791. PMID 37204656 | current |
| International multidisciplinary panel | 2024 | international | MAFLD | Dietary modification | Zeng XF, et al. Metabolism. 2024;161:156028. PMID 39270816 | current |
| International multidisciplinary panel | 2024 | international | MAFLD (paediatric) | Paediatric MAFLD consensus | Zhang L, et al. Med. 2024;5(7):797-815.e2. PMID 38677287 | current |
| NASPGHAN | 2017 | North America | NAFLD (paediatric) | Diagnosis and treatment in children | Vos MB, et al. J Pediatr Gastroenterol Nutr. 2017;64(2):319-334. PMID 28107283 | current for paediatrics; predates renaming |
| Global public health consensus (Delphi) | 2022 | international | NAFLD | Public health agenda, policy and leadership | Lazarus JV, et al. Nat Rev Gastroenterol Hepatol. 2022;19(1):60-78. PMID 34707258 | current |
| MAFLD definition consensus | 2020 | international | MAFLD | New definition | Eslam M, et al. Gastroenterology. 2020;158(7):1999-2014.e1. PMID 32044314 | parallel to MASLD |
| MAFLD diagnostic criteria | 2020 | international | MAFLD | International expert consensus on criteria | Eslam M, et al. J Hepatol. 2020;73(1):202-209. PMID 32278004 | parallel to MASLD |
| MAFLD multi-stakeholder endorsement | 2022 | international | MAFLD | Endorsement letter | Méndez-Sánchez N, et al. Lancet Gastroenterol Hepatol. 2022;7(5):388-390. PMID 35248211 | parallel to MASLD |
| WFUMB | 2024 | international | cross-aetiology | Liver ultrasound elastography (Part 1) | Ferraioli G, et al. Ultrasound Med Biol. 2024;50(8):1071-1087. PMID 38762390 | current |
| WFUMB | 2024 | international | cross-aetiology | Liver fat quantification (Part 2) | Ferraioli G, et al. Ultrasound Med Biol. 2024;50(8):1088-1098. PMID 38658207 | current |
| BSG / UK | 2018 | UK | cross-aetiology | Management of abnormal liver blood tests | Newsome PN, et al. Gut. 2018;67(1):6-19. PMID 29122851 | current |
| ILTS | 2019 | international | NAFLD/NASH | NAFLD/NASH and liver transplantation consensus | Burra P, et al. Transplantation. 2019;103(1):19-21. PMID 30365465 | current |
| ESPEN | 2020 | Europe | cross-aetiology | Clinical nutrition in liver disease (practical guideline) | Bischoff SC, et al. Clin Nutr. 2020;39(12):3533-3562. PMID 33213977 | current |
| FDA | 2024 | USA | MASH | Accelerated approval of resmetirom | "FDA Approves First Treatment for Patients with Liver Scarring Due to Fatty Liver Disease", https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-patients-liver-scarring-due-fatty-liver-disease, accessed 2026-09-02 | regulatory action |
| KASL | 2025 | South Korea | MASLD | Full national clinical practice guideline written to the 2023 nomenclature | Sohn W, et al. Clin Mol Hepatol. 2025;31(Suppl):S1-S31. PMID 39967303 | current |
| AISF | 2026 | Italy | MASLD/MASH | Pharmacological treatment; introduces the STEPS-MASH selection and monitoring framework for resmetirom and semaglutide | Associazione Italiana per lo Studio del Fegato. Dig Liver Dis. 2026;58(5):599-607. PMID 41864758 | current |
| INASL | 2023 | India | NAFLD (deliberately retained) | Nomenclature, diagnosis and treatment, written for Indian health infrastructure | Duseja A, et al. J Clin Exp Hepatol. 2023;13(2):273-302. PMID 36950481 | current |
| NICE (summary publication) | 2016 | UK | NAFLD | Journal summary of NICE NG49 assessment and management guidance | Glen J, et al. BMJ. 2016;354:i4428. PMID 27605111 | current (guideline itself unrevised since 2016) |
| AASLD | 2023 | USA | cross-aetiology | Practice guidance on drug, herbal and dietary supplement-induced liver injury — the exposure most relevant to self-treating MASLD patients | Fontana RJ, et al. Hepatology. 2023;77(3):1036-1065. PMID 35899384 | current |
Per-document notes on the ones that matter most¶
AASLD (PMID 36727674 + PMID 38445559 + PMID 41201884)¶
The 2023 Practice Guidance was written under NAFLD terminology and published shortly before the nomenclature statement; the 2024 companion states that MASLD and MASH may be read interchangeably for NAFLD and NASH throughout it. The November 2025 semaglutide update is the most operationally specific document in the field: it gives non-invasive selection thresholds (VCTE 8–15 kPa, MRE 3.1–4.4 kPa, ELF 9.2–10.5), a defined grey zone requiring cirrhosis exclusion, a monitored-risk list, one-year response markers, and the explicit statement that resmetirom plus semaglutide has not been studied.
EASL–EASD–EASO 2024 (PMID 38851997)¶
The first major guideline written natively in MASLD vocabulary, co-produced by hepatology, diabetes and obesity societies — a structural acknowledgement that the disease is not owned by one specialty.
APASL 2025 (PMID 40016576) and Chinese guideline 2024 (PMID 39544247)¶
Both written for MAFLD, not MASLD. MAFLD does not exclude concurrent liver disease and uses different alcohol handling, so recommendations from these documents apply to an overlapping but different population. This is the single largest structural divergence in the global guidance set.
Global consensus, 2025 and 2026 (PMIDs: 40222485, 41950980)¶
The 2025 Delphi was commissioned because differences among 61 guideline documents "created confusion, contributing to a low implementation rate and suboptimal management". The 2026 update, by 40 international experts across hepatology, gastroenterology, endocrinology, internal medicine and primary care, sets treatment thresholds (LSM 10–20 kPa or ELF 9.2–11.3 after excluding cirrhosis), recommends against upfront combination therapy, and defines one-year response as ≥30% LSM reduction or ≥0.5-point ELF reduction.
ADA 2025 (PMID 40434108)¶
The strongest screening statement from any body: fibrosis screening in prediabetes and type 2 diabetes as a new standard of care, with the explicit argument that liver health should be tracked as retinopathy, nephropathy and neuropathy are.
AGA lean-individuals update (PMID 35842345)¶
The only document that recommends against routine screening in a defined population (lean individuals in the general population), while recommending it above age 40 with type 2 diabetes. It also carries the field's most specific differential-diagnosis list for lean steatosis.
NICE NG49 (retrieved 2026-09-02)¶
Now titled for MASLD. Notable as the only major national guidance from a single-payer system, and therefore the one whose recommendations carry direct resource-allocation consequences.
MetALD position statement (PMID 39608457)¶
Not a guideline but the only document addressing the alcohol boundary in operational detail: quantify intake in grams per week, use AUDIT-C and phosphatidylethanol, take collateral history, re-assess over time, and be cautious about diagnosing MASLD on a single metabolic criterion above the weekly alcohol thresholds.
KASL 2025 (PMID 39967303)¶
A full national guideline written directly to the MASLD nomenclature rather than retrofitted to it. It matters disproportionately to this knowledge base because Korean national-insurance cohorts supply much of the observational drug evidence cited on other-pharmacotherapy.md and masld-and-type-2-diabetes.md; the guideline and the evidence come from the same health system.
AISF 2026 (PMID 41864758)¶
The only document in this registry to publish a named operational framework for drug therapy — STEPS-MASH — covering identification, selection and monitoring of patients eligible for resmetirom or semaglutide, and the only one to extend the pharmacological recommendation explicitly beyond high-risk populations to "broader metabolic populations". Where the 2026 global consensus states thresholds, AISF states a process.
INASL 2023 (PMID 36950481)¶
The clearest statement in the guidance set that international guidelines are not universally implementable: it says directly that existing guidelines "fail to capture the entire landscape of NAFLD in India" and are "often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure". It retains NAFLD deliberately, arguing the nomenclature debate "is creating undue confusion among clinical practitioners" — a third position distinct from both the MASLD and MAFLD camps. India's pooled adult prevalence is 38.6% (epidemiology-and-burden.md, PMID 35677499), so this is not a marginal dissent.
AASLD DILI guidance 2023 (PMID 35899384)¶
Included because it is the guidance that actually governs the commonest avoidable hazard in this population. Herbal and dietary supplements now account for 20% of US hepatotoxicity (PMID 27677775), and turmeric-associated injury — hepatocellular, latency 1–4 months, strongly linked to HLA-B*35:01, one death in ten adjudicated DILIN cases — is rising (PMID 36252717). No MASLD-specific guideline addresses supplement use.
Disagreements and gaps¶
| # | Question | Positions | Where discussed |
|---|---|---|---|
| 1 | Which vocabulary? | AASLD, EASL, ALEH, NICE, Japan, global consensus: MASLD. APASL and China: MAFLD. The definitions differ measurably in the population they capture | wiki/nomenclature-and-definitions.md |
| 2 | Screen the general population? | No body says yes. ADA says yes within prediabetes/T2D; AACE says case-find in primary care and endocrinology; AGA says explicitly not in lean general-population individuals | wiki/guidelines.md |
| 3 | Who owns the patient? | Hepatology-anchored (AASLD, EASL, APASL) vs endocrinology/primary-care entry (AACE, AGA pathway, ADA) vs formal inter-level referral protocols (Spain) vs a public-health response (Lazarus consensus) | wiki/guidelines.md |
| 4 | Is pioglitazone in the algorithm? | Present in ALEH 2025 and AACE 2022; absent from the 2026 global hepatology consensus, despite the largest randomised histological effect in type 2 diabetes | wiki/other-pharmacotherapy.md |
| 5 | HCC surveillance below cirrhosis? | ALEH: consider in advanced fibrosis by individual risk. AGA: consider for NIT-suggested F3–F4. Nobody extends to non-cirrhotic MASLD generally, where ~38.5% of MASLD-related HCC arises | wiki/masld-related-hepatocellular-carcinoma.md |
| 6 | Combination therapy | 2026 global consensus recommends against upfront combination; AASLD states it has not been studied; network meta-analysis ranks two combinations among the most effective for fibrosis | wiki/clinical-trials-landscape.md |
| 8 | Is an SGLT2 inhibitor MASH therapy? | ALEH lists SGLT2 inhibitors on observational grounds; no other body includes them. Since then dapagliflozin met all three histological endpoints in a 154-patient randomised trial (PMID 40467095), cited by no guideline retrieved on 2026-09-02 | wiki/other-pharmacotherapy.md |
| 9 | Should guidance be resource-stratified? | INASL alone states that international guidance is not implementable in its setting for infrastructure and sociocultural reasons (PMID 36950481); no international document offers a low-resource pathway, though every pathway begins with a test requiring elastography or an assay panel | wiki/guidelines.md |
| 10 | Which term does the public meet? | Both verified government portals (NHS, NIDDK) still titled their pages "non-alcoholic fatty liver disease" on 2026-09-02, three years after the rename, while professional bodies split three ways between MASLD, MAFLD and retained NAFLD | wiki/patient-experience-and-advocacy.md |
| 11 | Should alcohol intake be measured or asked? | The MetALD position statement recommends phosphatidylethanol alongside self-report and AUDIT-C; no guideline requires it, and 39.0% of self-report-classified MASLD has PEth in the MetALD/ALD range (PMID 40945520) | wiki/nomenclature-and-definitions.md |
| 7 | Alcohol threshold in practice | The MASLD definition permits intake up to the MetALD threshold; ALEH advises complete abstinence with significant fibrosis; the MetALD position statement warns the thresholds are unreliable without biomarker confirmation | wiki/red-flags-and-safety-concerns.md |
Structural gaps in the guidance set, as of 2026-09-02:
- Cirrhosis. No body recommends any pharmacotherapy for MASH cirrhosis, because every randomised trial in that population has missed its primary endpoint. Guidance handles cirrhosis by exclusion criteria.
- Genotype. No guideline incorporates PNPLA3 or polygenic risk into stratification; AGA states evidence is inadequate for routine genetic testing even in lean disease.
- Paediatrics. Two consensus documents exist (NASPGHAN 2017, international MAFLD consensus 2024) and no drug is approved for children.
- Implementation. No guideline has been evaluated for whether following it changes outcomes.
- Pregnancy. MASLD is associated with a 3.4-fold odds of preterm birth independent of obesity and familial factors (PMID 40630617) and a 2.4-fold odds of adverse pregnancy outcomes across 290,527 women (PMID 41307877). No hepatology guideline in this registry, and no obstetric guideline retrieved on 2026-09-02, identifies MASLD as an antenatal risk factor.
- Supplements. No MASLD guideline addresses herbal and dietary supplement use, despite this being the population most likely to self-treat and despite HDS accounting for 20% of US hepatotoxicity (PMID 27677775); the relevant guidance sits in a separate AASLD document (PMID 35899384).
- Portal hypertension in obesity. Baveno VII's rule-in criterion has a positive predictive value of 0.67 specifically in MASLD with obesity, correctable to 0.83 with an existing calculator (PMID 41138818). No guideline has adopted the correction.
Watch list¶
| Expected | What it would change |
|---|---|
| MAESTRO-NASH outcome phase (NCT03900429, to 2028) and MAESTRO-NASH OUTCOMES (NCT05500222, primary completion Dec 2026) | Conversion of resmetirom's accelerated approval; the first hard-outcome evidence for a MASH drug |
| ESSENCE full results (NCT04822181, to April 2029) | Conversion of semaglutide's accelerated approval |
| First positive trial in compensated MASH cirrhosis | Would force every guideline to add a cirrhosis section |
| Phase 3 readouts for FGF21 analogues and incretin multi-agonists | Would require a comparative-selection algorithm that no guideline currently provides |
| Genotype-directed programmes (ALN-HSD, ALN-PNP, AZD2693) reaching phase 3 | Would force the first genotype recommendation into a MASLD guideline |
| Any implementation or screening trial with clinical endpoints | Would move screening recommendations from prevalence-based to evidence-based |
| Longitudinal implementation study beyond immediate knowledge gain (PMID 41845319) | Would show whether training changes practice and patient outcomes |
| Reconciliation of MASLD and MAFLD | Would remove the largest structural divergence in the global guidance set |
| A confirmatory dapagliflozin trial outside China, or a regulatory submission | Would put a generic-track drug into the treatment algorithm and change access economics entirely (PMID 40467095) |
| Adoption of the ANTICIPATE±NASH correction to Baveno VII in a portal-hypertension guideline | Would fix the one criterion that fails specifically in MASLD with obesity (PMID 41138818) |
| Any guideline requiring an objective alcohol biomarker for SLD subclassification | Would change the composition of every MASLD cohort and trial population (PMID 40945520) |
| An obstetric or hepatology statement on MASLD in pregnancy | Would close the largest uncovered clinical setting in this registry (PMIDs: 40630617, 41307877) |