Lifestyle Medicine and Metabolic Dysfunction-Associated Steatotic Liver Disease in Viet Nam: What the Evidence Means for Prevention, Management and Referral

Lifestyle Medicine and Metabolic Dysfunction-Associated Steatotic Liver Disease in Viet Nam: What the Evidence Means for Prevention, Management and Referral

Last reviewed: 30 September 2026

Metabolic dysfunction-associated steatotic liver disease can be easy to underestimate. It may be discovered incidentally on an ultrasound, appear alongside obesity or type 2 diabetes, or be accompanied by only mild abnormalities in liver enzymes. Many people feel entirely well. Yet in some, the disease can progress from excess liver fat to steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma.

At the same time, this is not simply a “fatty liver” problem, and it should not be approached as one. Metabolic dysfunction-associated steatotic liver disease sits at the intersection of liver health and cardiometabolic health. Nutrition, physical activity, body composition, diabetes, blood pressure, lipids, alcohol exposure and other factors all matter. The clinical priority, however, is not to give everyone the same lifestyle advice. It is to understand what is driving the disease, identify who may have progressive liver injury, assess fibrosis risk, manage cardiometabolic disease and recognize who needs specialist evaluation.

This distinction is particularly relevant in Viet Nam, where metabolic disease is increasing while chronic viral hepatitis remains an important part of the liver disease landscape. Lifestyle Medicine can make an important contribution, but its role is strongest when integrated with appropriate diagnosis, fibrosis risk assessment, evidence-based treatment of cardiometabolic conditions and specialist care when needed.

What does MASLD mean, and why has the terminology changed?

In 2023, an international multisociety consensus introduced steatotic liver disease as an umbrella term for conditions characterized by hepatic steatosis. Metabolic dysfunction-associated steatotic liver disease, commonly abbreviated MASLD, replaced the former term non-alcoholic fatty liver disease. Within the current classification, MASLD is defined by hepatic steatosis together with at least one cardiometabolic risk factor and no other discernible primary cause of the steatosis. Importantly, making a diagnosis of MASLD does not mean that clinicians can ignore other liver diseases. Multiple causes and contributors can coexist, including viral hepatitis, alcohol exposure, medications and other conditions.[1]

Metabolic dysfunction-associated steatohepatitis, or MASH, replaces the former term non-alcoholic steatohepatitis. It refers to the steatohepatitis phenotype, characterized histologically by steatosis together with inflammation and hepatocellular injury, including ballooning, with or without fibrosis. The newer nomenclature also recognizes an overlap category, MetALD, for people with metabolic dysfunction whose alcohol exposure exceeds the range used for MASLD but remains within the defined overlap range between metabolic and alcohol-associated disease.[1]

The change is more than vocabulary. The previous terminology partly defined disease by what it was not, particularly alcohol use, while the terms “non-alcoholic” and “fatty” were considered stigmatizing by many participants in the international consensus process. The newer framework provides a positive diagnosis based on metabolic risk while retaining the need to identify alcohol and other causes of liver disease.

Healthcare professionals in Viet Nam may still encounter NAFLD, NASH, MAFLD, MASLD and MASH in clinical records, publications and older guidelines. These terms should not automatically be treated as interchangeable. In particular, metabolic dysfunction-associated fatty liver disease, or MAFLD, was proposed in 2020 using diagnostic criteria that differ from the later MASLD framework and explicitly permit coexistence with other chronic liver diseases. There is substantial overlap between the populations identified by MAFLD and MASLD, but the definitions are not identical.[2] This distinction matters when interpreting older Vietnamese studies or comparing prevalence estimates across publications.

Why does this matter for Viet Nam?

Reliable national prevalence data using the current MASLD definition remain limited. A 2025 review of Vietnamese evidence, primarily using the earlier MAFLD framework and studies conducted between 2015 and 2024, concluded that metabolic fatty liver disease affected more than one-quarter of adults in some urban populations. The review also highlighted increasing metabolic risk, limited diagnostic capacity, fragmented care and coexistence with chronic hepatitis B as important challenges. These estimates should not be interpreted as a national prevalence figure for MASLD because the underlying studies differed in populations, periods and diagnostic definitions.[3]

More recent Vietnamese studies reinforce the need for attention while also showing why local prevalence figures must be interpreted carefully. A hospital-based case-control study published in 2026 included 100 people with MASLD and 119 controls and identified associations with factors including higher body mass index and diabetes.[4] Because it was a case-control study conducted in a hospital setting, it was not designed to estimate population prevalence.

A separate cross-sectional study of 1,339 people undergoing periodic health examinations at University Medical Center Ho Chi Minh City from December 2025 to March 2026 reported MASLD in 39.88% of participants.[5] This is useful contemporary Vietnamese evidence, but it represents a selected health-check population rather than the general population of Viet Nam. It should therefore not be described as a national prevalence estimate.

The Asian context is also important. MASLD can occur in people who do not meet conventional definitions of overweight or obesity. International guidance uses ethnicity-specific body mass index thresholds when describing normal-weight or lean metabolic disease, with 23 kg/m² commonly used as the upper threshold for normal weight in Asian adults. Such individuals may still have visceral adiposity, insulin resistance, diabetes, dyslipidemia, low muscle mass or other metabolic abnormalities. A normal body mass index therefore does not exclude clinically important metabolic liver disease.[6][7]

The amount of liver fat is not the whole story

An ultrasound report describing “fatty liver” can easily become the focus of attention, but the amount of steatosis alone does not determine long-term liver risk. Fibrosis is one of the strongest predictors of liver-related outcomes in MASLD, and current clinical practice is increasingly centered on identifying people with significant or advanced fibrosis rather than simply documenting the presence of liver fat.[7][11][14]

This has practical consequences. A person with substantial steatosis but low fibrosis risk may primarily need structured cardiometabolic and lifestyle management with appropriate follow-up. Another person with less striking steatosis but evidence suggesting advanced fibrosis may require specialist assessment and more intensive monitoring.

Normal liver enzymes also do not reliably exclude important disease. Alanine aminotransferase and aspartate aminotransferase measurements alone are less accurate for detecting fibrosis than validated non-invasive fibrosis tools. Normal or mildly abnormal liver enzymes should therefore not be used as reassurance when a person's overall clinical risk suggests that fibrosis assessment is appropriate.

Who should be assessed for progressive disease?

Current international guidance does not support indiscriminate screening of the entire population for MASLD. Instead, it emphasizes case finding in people at higher risk, particularly those with type 2 diabetes, abdominal obesity together with additional cardiometabolic risk factors, persistently abnormal liver tests or radiological evidence of hepatic steatosis. The purpose is not simply to confirm liver fat. It is to identify people who may have clinically significant fibrosis and who could benefit from further assessment or treatment.[7]

A widely used first-line tool is the fibrosis-4 index, commonly called FIB-4, calculated from age, platelet count, alanine aminotransferase and aspartate aminotransferase. In many adult pathways, a FIB-4 below 1.3 indicates relatively low risk and usually leads to periodic reassessment rather than immediate specialist testing. Results from 1.3 to 2.67 generally require further risk stratification, commonly with vibration-controlled transient elastography or, where available, an enhanced liver fibrosis test.[7][8][14]

A value above 2.67 indicates a higher probability of advanced fibrosis, but international pathways are not identical. Some recommend specialist referral at this level, while others use a second non-invasive test before determining referral. Age also affects interpretation. FIB-4 has limited accuracy in adults younger than 35, while a higher lower cut-off of 2.0 is commonly used in adults aged 65 years or older because age can otherwise produce false-positive results. FIB-4 should therefore be treated as a risk-stratification tool rather than a diagnosis or stand-alone decision rule.

These are international clinical pathways and should not be presented as a Vietnamese national MASLD protocol. Their use in Viet Nam should take account of clinical context, comorbidities, local resources, availability of elastography and specialist services, and professional judgment.

Lifestyle intervention is treatment, but “lifestyle only” is not the principle

Lifestyle intervention remains foundational in MASLD, but that phrase can be misleading if it means simply telling a patient to lose weight, exercise more and return several months later. Effective Lifestyle Medicine is more structured. It includes assessment, individualized goals, behavior-change support, follow-up and attention to the barriers that affect whether change is realistic and sustainable.

Lifestyle intervention should also occur alongside appropriate treatment of type 2 diabetes, hypertension, dyslipidemia, obesity and other relevant conditions rather than competing with conventional care. The Lifestyle Medicine Core Competencies: 2025 Update emphasize evidence-based interventions, behavior change, clinical processes, interprofessional care and outcome assessment rather than simple advice.[9] The competencies were published in their final journal issue in March 2026.

The direct evidence for MASLD is strongest for weight management where appropriate, dietary quality, physical activity and reduction or avoidance of alcohol. Sleep, stress management, social connection and tobacco avoidance remain relevant to broader cardiometabolic health, well-being and the sustainability of behavior change, but they should not be presented as though every Lifestyle Medicine pillar has equally strong evidence for reversing steatohepatitis or liver fibrosis.

Weight loss can improve liver disease, but the target depends on the patient

For adults with MASLD and overweight or obesity, sustained weight reduction is associated with progressively greater improvements in liver disease. Current European guidance recommends aiming for at least 5% weight reduction to reduce liver fat, 7-10% to improve liver inflammation, and at least 10% to improve fibrosis.[7] These are therapeutic targets derived from population-level evidence, not guaranteed outcomes for every individual.

The emphasis should be on sustainable change rather than rapid short-term weight loss. Behavioral support, realistic goals, self-monitoring and follow-up are therefore part of treatment, not optional extras.

Weight loss should also not become a universal prescription for every person with MASLD. People with normal-weight MASLD can still benefit from better dietary quality, physical activity and improvement in metabolic health, but evidence for the effect of intentional weight loss on fibrosis and long-term liver outcomes in this group is less certain. For a Vietnamese patient with normal body weight, assessment may therefore need to focus more broadly on visceral adiposity, dietary quality, physical inactivity, diabetes, dyslipidemia, muscle mass and other metabolic factors rather than assuming that substantial weight loss is required.

Nutrition should improve the overall pattern, not create another restrictive diet

There is no single food that causes MASLD and no evidence-based “liver detox diet” that treats it. Current guidance supports improving overall dietary quality, with patterns broadly similar to a Mediterranean-style diet and greater intake of minimally processed foods, vegetables, fruits, whole grains, legumes, nuts and sources of unsaturated fat. It also recommends reducing sugar-sweetened beverages, processed meats and ultra-processed foods.[7]

For Viet Nam, this does not mean importing a Mediterranean menu. The underlying principles can be translated into Vietnamese eating patterns using vegetables and herbs, legumes and soy foods, fruit, whole or less-refined grains where practical, nuts and seeds, fish and other appropriate protein sources, while reducing frequent consumption of sugar-sweetened beverages, highly processed snacks, processed meats and excessive energy-dense foods.

The more useful question is not whether a diet carries a particular label, but whether it is nutritionally appropriate, culturally realistic, affordable, sustainable and capable of improving metabolic health. Nutrition plans also need to change with disease severity. Someone with advanced cirrhosis, sarcopenia or other nutritional problems may require very different management from a person with uncomplicated MASLD and obesity.

Nutritional supplements, herbal products, probiotics and other nutraceuticals are frequently promoted for “fatty liver.” Current European guidance does not recommend nutraceuticals as routine MASLD treatment because evidence remains insufficient regarding clinically meaningful effects on liver injury, fibrosis and outcomes, as well as long-term safety.[7] This is particularly relevant in Viet Nam, where some patients may use traditional, herbal or over-the-counter products without reporting them during medical consultations.

Physical activity has benefits even when weight does not change dramatically

Physical activity should not be viewed only as a way to create a calorie deficit. It can improve cardiometabolic health, fitness and liver fat even when weight change is modest. International guidance supports regular physical activity tailored to the person's capacity, health status and preferences, with aerobic activity, resistance exercise and reduction of sedentary time all potentially contributing to care.[7]

For many adults, a practical general target is at least around 150 minutes of moderate-intensity activity per week or an equivalent amount of vigorous activity, while recognizing that the appropriate prescription should be individualized. The most useful program is not necessarily the most intense one. Someone with cardiovascular disease, severe obesity, advanced liver disease, musculoskeletal limitations or marked deconditioning may require clinical assessment and gradual progression. Referral to appropriately qualified exercise, rehabilitation or other healthcare professionals may be useful when more specialized planning is required.

Alcohol should not be ignored simply because the disease is “metabolic”

The newer steatotic liver disease framework makes the interaction between metabolic dysfunction and alcohol clearer. Alcohol exposure and metabolic risk can independently contribute to liver disease and may act synergistically. Current evidence does not justify recommending light or moderate alcohol intake as a strategy to protect liver or cardiometabolic health in people with MASLD.[7]

A meaningful alcohol history therefore belongs in the assessment of every person with steatotic liver disease. European guidance recommends discouraging alcohol consumption, particularly at moderate or higher levels, and recommends complete and permanent abstinence for people with advanced fibrosis or cirrhosis.[7]

Where alcohol exposure exceeds the range used for MASLD, clinicians should consider the appropriate steatotic liver disease category rather than automatically attributing all steatosis in a metabolically unhealthy patient to MASLD.

Diabetes, obesity and cardiovascular risk cannot be treated separately from the liver

MASLD is closely connected with type 2 diabetes, abdominal adiposity, hypertension and dyslipidemia. Treating the liver while ignoring these conditions misses much of the disease. Current guidance supports multidisciplinary management of cardiometabolic comorbidities, including evidence-based treatment of diabetes, obesity, blood pressure and lipid abnormalities.[7]

Statins, for example, should not routinely be withheld merely because someone has MASLD or compensated chronic liver disease when they are otherwise indicated for cardiovascular risk reduction. Lifestyle interventions can complement this care because improvements in nutrition, physical activity and weight where appropriate may influence several cardiometabolic conditions simultaneously. Lifestyle Medicine should therefore strengthen evidence-based pharmacotherapy when indicated, not delay or replace it.

Viral hepatitis remains especially important in Viet Nam

Viet Nam's liver disease context differs from that of many settings in which MASLD guidance has been developed because chronic viral hepatitis, particularly hepatitis B, remains clinically important. A person can have metabolic steatotic liver disease and chronic hepatitis B at the same time. Finding one diagnosis should not lead clinicians to stop looking for the other.

This became even more relevant in June 2026, when the Ministry of Health issued Decision No. 1740/QĐ-BYT, updating the national guidance for diagnosis and treatment of hepatitis B virus infection. The new guidance broadened treatment indications and explicitly includes metabolic comorbidities among factors that can influence treatment decisions in people with detectable hepatitis B virus DNA.[10]

A person with steatosis or abnormal liver enzymes should therefore not automatically be told that the problem is “lifestyle-related.” Depending on the clinical context, evaluation may need to consider hepatitis B and C, alcohol, medications and supplements, autoimmune disease, inherited disorders and other causes of liver injury. MASLD can coexist with other liver diseases, and each clinically relevant driver requires appropriate assessment and management.

When should referral be considered?

Not everyone with low-risk MASLD needs ongoing management in a specialist liver clinic. Primary care, internal medicine, endocrinology, obesity services and other clinical settings can play major roles in lifestyle intervention and cardiometabolic management. Referral becomes more important when there is evidence of significant or advanced fibrosis, suspected cirrhosis, diagnostic uncertainty, persistently unexplained liver enzyme abnormalities, thrombocytopenia, concerning elastography findings, signs of portal hypertension or another liver disease requiring specialist care.

For intermediate FIB-4 results, a second non-invasive test such as vibration-controlled transient elastography or an enhanced liver fibrosis test is commonly used before deciding on referral. A FIB-4 above 2.67 represents a higher-risk range, but different international pathways vary between direct specialist referral and additional non-invasive testing before referral.[7][8]

The important point is not one number alone. FIB-4, elastography and other non-invasive tests estimate risk and should be interpreted together with age, clinical findings, laboratory results, imaging and other liver disease risks. The updated 2026 international consensus continues to place sequential non-invasive fibrosis assessment at the center of risk stratification.[14]

Liver biopsy is no longer required simply to manage every person with MASLD. Non-invasive tests allow many patients to be categorized as lower or higher risk without biopsy. Histology remains relevant in selected cases, including diagnostic uncertainty and situations where definitive characterization of steatohepatitis or another liver disease is clinically necessary.

The treatment landscape has changed rapidly

For many years, there was no liver-directed medicine specifically approved in the United States for progressive steatohepatitis with fibrosis. That changed in 2024 and 2025.

In March 2024, the United States Food and Drug Administration granted accelerated approval to Rezdiffra (resmetirom), together with diet and exercise, for adults with noncirrhotic non-alcoholic steatohepatitis, now generally termed MASH, with moderate-to-advanced liver fibrosis. The approval was based on histological surrogate endpoints, while the longer-term study continues to verify clinical benefit.[12]

In 2025, the United States Food and Drug Administration also granted accelerated approval to Wegovy (semaglutide) for adults with MASH and moderate-to-advanced fibrosis. In the interim phase 3 analysis cited by the FDA, semaglutide improved both MASH resolution and fibrosis outcomes compared with placebo, while the trial continues to determine whether these histological improvements translate into fewer major liver-related clinical events over time.[13]

The updated international consensus published in September 2026 now incorporates both resmetirom and semaglutide into fibrosis-focused treatment algorithms for selected adults with noncirrhotic disease and significant fibrosis. It recommends sequential non-invasive risk stratification, individualized treatment selection according to cardiometabolic profile and shared decision-making, and does not recommend routine upfront combination treatment with both drugs.[14]

These developments do not make lifestyle treatment obsolete. They reinforce a more comprehensive model in which pharmacologic and lifestyle treatments are integrated according to disease severity and patient characteristics.

It is also essential not to extrapolate United States regulatory decisions directly to Viet Nam. Approval by the United States Food and Drug Administration does not mean that the same medicine has the same approved indication, availability, reimbursement status or prescribing conditions in Viet Nam. Clinicians should verify current product registration, approved indications and regulatory authorization from the Ministry of Health and Drug Administration of Viet Nam at the time treatment is considered.

For people with obesity who otherwise meet established indications, metabolic or bariatric surgery may also improve weight-related metabolic disease and MASLD. International guidance recognizes it as a potential therapeutic option in appropriately selected patients, but it is not a general treatment for everyone with steatotic liver disease and requires multidisciplinary assessment.[7]

What should Lifestyle Medicine contribute?

Lifestyle Medicine can make an important contribution to MASLD precisely because the disease rarely results from one isolated factor. It provides a framework for translating evidence about nutrition, physical activity, body weight, alcohol and behavior change into longitudinal clinical care.

But the field should resist oversimplification. Lifestyle Medicine should not imply that people with MASLD have caused their own disease. Genetics, visceral adiposity, diabetes, medications, socioeconomic circumstances, food environments and other clinical and structural factors may contribute. It should not imply that people with normal body weight are protected, or describe supplements, detox regimens, fasting protocols or highly restrictive diets as established liver treatments when the evidence does not support those claims.

Most importantly, lifestyle intervention should not be used as a substitute for fibrosis assessment, appropriate cardiometabolic medication, antiviral therapy, diagnosis of other liver diseases or specialist care when these are indicated. The strongest model is an integrated one: identify metabolic risk, support sustainable behavior change, manage cardiometabolic disease, assess fibrosis, recognize other causes of liver injury and escalate care when risk increases.

What could this mean for Vietnamese healthcare?

MASLD is likely to be encountered increasingly outside specialist hepatology services. Patients may first be identified during periodic health examinations, diabetes follow-up, obesity care, cardiovascular risk assessment, routine blood testing or abdominal ultrasound performed for another reason. Recent Vietnamese evidence from both hospital-based research and periodic health-check populations highlights the clinical relevance of the condition, although national prevalence using the current MASLD definition remains uncertain.[3][4][5]

A practical approach in Viet Nam could begin with recognition of hepatic steatosis or a high-risk metabolic profile, followed by assessment of cardiometabolic risk, alcohol use and other potential causes of liver disease. A simple first-line fibrosis assessment can then help determine who can continue structured metabolic and lifestyle management with follow-up and who requires additional non-invasive testing or specialist evaluation.

Such an approach may be particularly useful where access to advanced hepatology testing is uneven. FIB-4 uses routinely available laboratory and clinical information, making it potentially useful for initial risk stratification, but it should not be treated as sufficient by itself.

Viet Nam also needs stronger local evidence. Priorities include national epidemiological studies using the current MASLD definition, longitudinal data on disease progression and outcomes, local validation of non-invasive fibrosis pathways, implementation research across primary care and hospital settings, health-economic analysis and stronger Vietnamese representation in therapeutic trials. The rapid evolution of international treatment makes these research gaps more important, not less.

Clinical roles and legal boundaries still matter

Lifestyle Medicine terminology does not expand a healthcare professional's legally authorized scope of practice in Viet Nam. Medical examination, diagnosis, treatment and prescribing remain subject to Viet Nam's healthcare licensing and professional framework. The current consolidated text of the Law on Medical Examination and Treatment is Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on 26 February 2026. It reflects the Law on Medical Examination and Treatment together with subsequent amendments applicable by 2026.[15]

General education about nutrition, physical activity and health risk reduction is different from diagnosing MASLD, interpreting an individual's fibrosis investigations, prescribing pharmacotherapy, modifying diabetes or lipid-lowering medication, managing cirrhosis or determining that specialist referral is unnecessary. Healthcare professionals should work within their qualifications, professional competence and authorized scope, and refer when the clinical situation requires expertise or care beyond that scope.

This distinction becomes increasingly important as MASLD becomes more treatable. More therapeutic options create more opportunities for patients, but they also make accurate diagnosis, fibrosis risk stratification, appropriate treatment selection, monitoring and multidisciplinary collaboration more important rather than less.

The main message

Metabolic dysfunction-associated steatotic liver disease should no longer be approached as an incidental ultrasound finding followed by a simple instruction to “lose weight.” Sustainable improvements in nutrition, physical activity and body weight where appropriate can meaningfully improve liver fat and inflammation and, with sufficient sustained weight reduction in some patients, fibrosis. But lifestyle intervention is only one part of good MASLD care.

The more useful clinical questions are: What is driving this person's liver disease? What is the fibrosis risk? Which cardiometabolic conditions need treatment? Are alcohol, viral hepatitis or other liver diseases contributing? And does this person need specialist care?

For Viet Nam, Lifestyle Medicine can help strengthen prevention, behavior change and long-term cardiometabolic management. Its role is most credible and most useful when it operates inside evidence-based medical care, not as an alternative to it.

Professional education notice

This resource is intended for professional education and knowledge exchange. It does not constitute individualized medical advice, establish a Vietnamese clinical guideline, recommend a specific medicine for an individual patient, confer professional certification or scope of practice, or replace appropriate liver assessment, applicable clinical guidelines, specialist consultation, professional judgment, regulatory requirements or Vietnamese law. Drug indications, registrations and regulatory approvals may change and should be verified against current Vietnamese authorization at the time of prescribing.

References

1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology. 2023;79(6):1542-1556. doi:10.1016/j.jhep.2023.06.003.

2. Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. Journal of Hepatology. 2020;73(1):202-209. doi:10.1016/j.jhep.2020.03.039.

3. Vo TD, Lam HT. MAFLD in Vietnam: a neglected public health challenge requiring urgent policy action. Frontiers in Clinical Diabetes and Healthcare. 2025;6:1687149. doi:10.3389/fcdhc.2025.1687149.

4. Pham AG, Le AVK, Pham YTH, et al. Predictors of metabolic dysfunction-associated steatotic liver diseases (MASLD) in Vietnamese population. Scientific Reports. 2026;16:17802. doi:10.1038/s41598-026-45659-y.

5. Nguyen DD, Van HT, Nguyen TCM, et al. Prevalence of MASLD and coexisting metabolic disorders among individuals undergoing routine health check-up at University Medical Center Ho Chi Minh City. Vietnam Journal of Community Medicine. 2026;67(CD14). doi:10.52163/yhc.v67iCD14.6473.

6. Kobayashi T, Yoneda M, Duseja A, Fan JG, Nersesov A, Nakajima A. Metabolic Dysfunction-Associated Steatotic Liver Disease in Asia: Epidemiology, Clinical Features, and Management. Clinics in Liver Disease. 2026;30(2):495-511. doi:10.1016/j.cld.2026.01.010.

7. European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease. Journal of Hepatology. 2024;81(3):492-542. doi:10.1016/j.jhep.2024.04.031.

8. American Diabetes Association. Metabolic Dysfunction-Associated Steatotic Liver Disease in People With Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association. Diabetes Care. 2025;48(7):1057-1080.

9. Rea BL, Cheema S, Lanza S, Makinde MT, Matthews S, Palma M, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443-451. doi:10.1177/15598276251379821. Universidad Andrés Bello

10. Ministry of Health of Viet Nam. Decision No. 1740/QĐ-BYT issuing the Guidelines for Diagnosis and Treatment of Hepatitis B Virus Infection. 16 June 2026.

11. Akuta N, Kogiso T, Ikejima K, et al. Evidence-Based Clinical Practice Guidelines for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) 2026. Hepatology Research. 2026;56(6):887-902. doi:10.1111/hepr.70188.

12. United States Food and Drug Administration. FDA Approves First Treatment for Patients with Liver Scarring Due to Fatty Liver Disease. 14 March 2024.

13. United States Food and Drug Administration. FDA Approves Treatment for Serious Liver Disease Known as ‘MASH’. 2025.

14. Younossi ZM, Kalligeros M, Wong VWS, et al. Updated Global Consensus Recommendations for Risk Stratification, Treatment Initiation, and Response Monitoring in Metabolic Dysfunction-Associated Steatotic Liver Disease. Clinical Gastroenterology and Hepatology. 2026;24(9):2333-2347. doi:10.1016/j.cgh.2026.03.030. University of Haifa

15. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. 26 February 2026.

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