Opportunities for the management of metabolic dysfunction-associated fatty liver disease within Aboriginal and Torres Strait Islander peoples

Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) is frequently acknowledged as the hepatic manifestation of the metabolic syndrome1 and is characterised by the excessive accumulation of hepatic fat2 within the setting of obesity, type 2 diabetes (T2D) and/or metabolic dysregulation.3 MAFLD is the leading cause of liver disease worldwide,4 with a 20-30% prevalence globally and within Australia.5 MAFLD is strongly linked to both liverspecific morbidity and mortality and extrahepatic morbidity and mortality, notably T2D, cardiovascular disease (CVD) and lifestylerelated cancers.6,7 In Australia, the prevalence of MAFLD is expected to increase by 25% between 2019 and 2030, paralleling trends of increasing obesity and diabetes.8 Concerningly, prevalence is likely underestimated due to the asymptomatic and non-specific nature of the condition in its early stages, lack of awareness and communitylevel screening, and lack of diagnosis until the disease has progressed to later stages.4,9 While the therapeutic landscape for MAFLD management is likely to change with recent advances in Phase III clinical trials,10 there are currently no approved pharmacological agents for the long-term management of MAFLD. Lifestyle therapy is the cornerstone of MAFLD management, with adiposity loss via improved diet quality and increased physical activity/exercise central to MAFLD regression, the prevention of MAFLD progression, and reducing the risk of CVD, T2D and lifestyle-related cancers