Metabolic dysfunction-associated fatty liver disease: Current updates and the Bangladesh perspective

Abstract

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) has emerged as one of the most common causes of chronic liver disease worldwide. The increasing prevalence of obesity, diabetes mellitus, sedentary lifestyle, and unhealthy dietary patterns has contributed to the growing burden of MAFLD in Bangladesh. The disease is strongly associated with insulin resistance, metabolic syndrome, cardiovascular disease, and progressive liver fibrosis. Objective: This abstract aims to summarize the current understanding of MAFLD, focusing on epidemiology, risk factors, diagnostic approaches, and management perspectives in Bangladesh. Methods: A narrative review was conducted based on available epidemiological studies, clinical evidence, and updated recommendations regarding MAFLD in Bangladesh and globally. Results: The global prevalence of MAFLD has increased to more than 30%, with 10–30% of affected individuals developing metabolic dysfunction-associated steatohepatitis (MASH). Bangladesh represents a high-burden region, with a reported MAFLD prevalence of 33.86%. Overweight, obesity, and diabetes are major contributors, with obese individuals showing substantially increased odds of MAFLD development. A significant proportion of Bangladeshi patients demonstrate progressive disease, with 42.4% of biopsy-confirmed fatty liver disease patients showing definitive MASH. Emerging evidence also highlights the presence of lean MAFLD and lean MASH, demonstrating that the disease is not restricted to obese individuals. Diagnosis relies on assessment of hepatic steatosis, metabolic risk factors, and non-invasive fibrosis evaluation tools such as Fibrosis-4 (FIB-4) index, vibration-controlled transient elastography, and other fibrosis markers. Lifestyle modification, including dietary optimization, weight reduction, and regular physical activity, remains the cornerstone of management. Recent targeted therapeutic approaches, including resmetirom and semaglutide, have shown promising roles in improving MASH resolution, fibrosis outcomes, metabolic control, and overall disease management. Conclusion: MAFLD is an increasing public health challenge in Bangladesh. Early identification of high-risk individuals, appropriate fibrosis assessment, lifestyle intervention, and multidisciplinary management are essential to reduce disease progression and liver-related complications. Integration of emerging targeted therapies with preventive strategies may provide new opportunities for improving outcomes among patients with progressive MAFLD. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2026;5 (Suppl 1): S2]