Table 1.
Comparison of common guidelines for the management of MAFLD.
| Interventions | AASLD Practice Guideline[36] | EASL-EASD-EASO Clinical Practice Guideline[38] | The Asian Pacific Association for the Study of the Liver Clinical Practice Guideline[39] | AISF[40] | NICE[41] |
| Lifestyle intervention | |||||
| Exercise | 200 min/week, moderate intensity | Aerobic exercise and resistance training | Aerobic exercise and resistance training | Aerobic exercise and resistance training | Recommended |
| Diet | Low-calorie diet | Dietary restrictions | Energy restriction and exclusion of processed foods; avoid foods or drinks high in fructose. A Mediterranean-pattern composition is recommended. | Low-calorie, low-carb, low-fat and high fiber diet.Gold standard is the Mediterranean dietary pattern. | No specific outline |
| Target weight loss | 3% to 5% of body weight | 7% of body weight | 7% to 10% of body weight | Not recommended | Recommended |
| Pharmacological intervention | |||||
| Metformin | Not recommended | Insufficient evidence | May be beneficial for treating MAFLD-HCC patients with Type 2 diabetes | Not recommended | Not recommended |
| Pioglitazone | Only for biopsy proven MeSH | To treat diabetes in patient with concurrent MAFLD | Improves histological features of MAFLD | Could be beneficial but insufficient evidence | Only for adults with advanced fibrosis with or without diabetes |
| Vitamin E | Could be used for biopsy proven steatohepatitis | Could be beneficial but insufficient evidence | May improve liver histology; however, some concerns about safety | Not beneficial | Not mentioned |
| GLP-1 Agonists | Insufficient evidence | Insufficient evidence | Not mentioned | Insufficient evidence | Insufficient evidence |
| OCA | Insufficient evidence | Insufficient evidence | Awaiting study results | Awaiting study results | Not mentioned |
| Silymarin | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Potential for use but insufficient evidence |
| Statins | Safe but not beneficial | Safe but not beneficial | Reduces cardiovascular morbidity and mortality | Safe but not beneficial | Safe but not beneficial |
| Surgical intervention | |||||
| Bariatric Surgery | Can consider foregut bariatric surgery for eligible obese patients with confirmed steatohepatitis | An option for patients that do not respond to lifestyle or pharmacological interventions | Decision should be individualized due to risk of post-operative complications | Not mentioned | Not mentioned |
AISF: Italian Association for the Study of the Liver; GLP-1: Glucagon-like peptide-1; HCC: Hepatocellular carcinoma; MAFLD: Metabolic (dysfunction) Associated Fatty Liver Disease; MeSH: Metabolic steatohepatitis; NICE: National Institute for Health and Care Excellence; OCA: Obeticholic acid.