Key points
- All agree: FIB-4 first (1.3 and 2.67), then elastography. A liver stiffness below 8 kPa is low risk.
- Names differ: Western and global documents use MASLD; Asian, Chinese and Egyptian guidelines use MAFLD. The patients are largely the same.
- They differ most on drugs: how to select patients for resmetirom, and whether vitamin E or pioglitazone count as liver treatment.
- Always check the full guideline and your local drug approvals.
1Diagnosis and staging
| Guideline | Name | First step | Second step | Retest if low risk |
|---|---|---|---|---|
| EASL–EASD–EASO 2024 | MASLD | FIB-4 <1.3 / ≥1.3 | VCTE <8 / ≥12 kPa, or ELF <7.7 / ≥9.8 | Every 1–3 years |
| AASLD 2023 | NAFLD, renamed MASLD in 2023 | FIB-4 <1.3 / 1.3–2.67 / >2.67 | VCTE <8 / 8–12 / >12 kPa, or ELF <7.7 / ≥9.8 | 2–3 years; 1–2 years with diabetes or ≥2 risk factors |
| Global consensus 2025 | MASLD | FIB-4 <1.3 (<2.0 if ≥65) | VCTE ≥8 kPa = at risk | — |
| APASL 2025 | MAFLD | FIB-4 <1.3 / 1.3–2.67 / >2.67 | VCTE <8 kPa rules out; ELF as an option | 2–3 years |
| Chinese 2024 | MAFLD | FIB-4 <1.3 / ≥2.67 | VCTE <8 / >12 kPa (advanced fibrosis); <10 / >15 kPa (cirrhosis) | — |
| Egyptian 2022 | MAFLD | FIB-4 1.3 / 2.67, NFS, or APRI 0.5 / 1.5 | Elastography; LSM >15 kPa suggests cirrhosis | — |
| Saudi consensus 2026 | MASLD | FIB-4 <1.3 low; ≥2.67 high (refer without delay) | VCTE <8 low; 8–12 intermediate: refer to gastroenterology/hepatology; >12 kPa high | LSM <8 kPa: every 2–3 years |
"—" means we have not summarised that point yet. It does not mean the guideline is silent. The Saudi consensus sends the 8–12 kPa group to a specialist, where EASL and AASLD treat it as a grey zone that may be resolved with a further test.
2Medicines
| Guideline | Resmetirom | Vitamin E | Pioglitazone |
|---|---|---|---|
| EASL–EASD–EASO 2024 | Consider where approved, in non-cirrhotic MASH with significant fibrosis (e.g. VCTE ≥10 kPa, MRE ≥5 kPa or ELF ≥9.8, without cirrhosis) | Not as MASH treatment | Safe; not as MASH treatment |
| AASLD 2023 + 2024 update | VCTE 8–15 kPa or MRE 3.1–4.4 kPa; not if VCTE >20 kPa | Consider in selected people | Consider with type 2 diabetes |
| Global consensus 2025 | VCTE 8–<16 kPa; 16–20 kPa if a second test excludes cirrhosis; not if >20 kPa | Only selected people without diabetes or cirrhosis | For diabetes, not as MASH treatment |
| APASL 2025 | Improves inflammation and fibrosis; prescribe within a specialist team | May improve histology | Improves histology |
| Egyptian 2022 | Before approval | May improve histology | Improves histology |
| Saudi consensus 2026 | 80–100 mg daily may be considered for MASH with fibrosis; more real-world evidence needed; not yet approved in Saudi Arabia at the time of writing | Can be considered in MASH without type 2 diabetes | Recommended in type 2 diabetes with biopsy-proven MASH and advanced fibrosis |
Summaries of each document's own words, checked against the full texts in October 2026.
Related topics
References
- EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD. J Hepatol 2024;81:492–542. doi:10.1016/j.jhep.2024.04.031
- Rinella ME, et al. AASLD Practice Guidance on the clinical assessment and management of NAFLD. Hepatology 2023;77:1797–835. doi:10.1097/HEP.0000000000000323
- Chen VL, et al. Resmetirom therapy for MASLD: October 2024 updates to AASLD Practice Guidance. Hepatology 2025;81(1):312–20. doi:10.1097/HEP.0000000000001112
- Younossi ZM, et al. Global consensus recommendations for MASLD and MASH. Gastroenterology 2025;169(5):1017–32. doi:10.1053/j.gastro.2025.02.044
- Eslam M, et al. APASL clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease. Hepatol Int 2025;19(2):261–301. doi:10.1007/s12072-024-10774-3
- Fan JG, et al. Guideline for the prevention and treatment of metabolic dysfunction-associated fatty liver disease (version 2024). J Clin Transl Hepatol 2024;12(11):955–74. doi:10.14218/JCTH.2024.00311
- Fouad Y, et al. The Egyptian clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Saudi J Gastroenterol 2022;28(1):3–20. doi:10.4103/sjg.sjg_357_21
- Abaalkhail F, et al. MASLD management in Saudi Arabia: a modified Delphi-based adaptation of international standards. Saudi J Gastroenterol 2026;32(2):104–20. doi:10.4103/sjg.sjg_199_25
How to cite this page
Desoky M. MASLD guidelines side by side. Metabolic Liver Academy quick reference, version 1.0. Updated 2026-10-03. Available from: https://drmahmouddesoky.github.io/metabolic-liver-academy/ref/guidelines-compared.html
A summary of published guidelines for healthcare professionals. It does not replace clinical judgement, the full guidelines or local drug labels. Disclaimer.