Metabolic-associated fatty liver disease (MAFLD) also known as non-alcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease in the Western world. However, optimal therapy has not yet been discovered and is currently based on identification of risk factors with dietary and lifestyle modifications.

The obesity epidemic has led to a dramatic increase in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). While dyslipidemia, type 2 diabetes, and cardiovascular disease guide treatment in patients without evidence of liver fibrosis, liver-related morbidity and mortality become relevant in advanced forms of MAFLD, nonalcoholic steatohepatitis (NASH), and when liver fibrosis develops. Statins should be prescribed for patients without significant fibrosis despite concomitant liver disease but are underused in real-world settings.

With the growing obesity epidemic and the rise of metabolic dysfunction-associated fatty liver disease/non-alcoholic steatohepatitis, the management of patients with chronic liver disease has become quite complex. Patients with metabolic dysfunction-associated fatty liver disease/non-alcoholic steatohepatitis often have multiple comorbidities, exhibiting various features of the metabolic syndrome, increasing the risk of cardiovascular morbidity and mortality.

Bariatric surgery, particularly Y-Roux bypass, has been shown to be superior to conservative and/or medical treatment for weight loss and resolution of obesity-related morbidities, but carries risks of surgical complications, reoperation, and very rarely, paradoxical progression of nonalcoholic steatohepatitis.

In recent decades, the proportion of contributions of different causes to the total burden of chronic liver disease has changed.