Best buys for metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: a global Delphi study

Background: An estimated one in three adults is living with metabolic dysfunction-associated steatotic liver disease (MASLD) globally, among whom 20–25% progress to metabolic dysfunction-associated steatohepatitis (MASH). Despite their hepatic and extrahepatic burden, MASLD and MASH remain absent from the WHO non-communicable disease (NCD) global action plan and its so-called best buys. This study aimed to identify MASLD and MASH interventions that can be considered as WHO best buys and determine whether they can also be quick buys (ie, interventions that can have real public health impact within 5 years). Methods: A core group developed 15 evidence-based intervention briefs following a literature review. These interventions were assessed for feasibility and potential impact, and whether they could also be considered as quick buys, by a global stakeholder panel in one Delphi round. Consensus was defined as 80% or higher combined agreement (ie, responses of agree plus somewhat agree). Findings: A total of 321 experts who worked in 85 countries participated. All 15 proposed interventions reached consensus and garnered a combined agreement higher than 86%. For 12 of the interventions, fewer than 80% of panellists selected agree, leading to a higher reliance on responses of somewhat agree to reach a high combined agreement. The highest-rated best buy was “Manage overweight, obesity, and type 2 diabetes in people living with MASLD” (99% combined agreement). “Routine screening for liver fibrosis in people living with type 2 diabetes” was the most endorsed quick buy (88%). Interpretation: This study shows a strong global consensus among experts that a range of interventions for MASLD and MASH meet the criteria for inclusion as WHO best buys. The high level of endorsement across the 15 interventions highlights the opportunity for global health systems to act on MASLD and MASH, providing a roadmap for policy makers to align liver health strategies with those of other NCDs. Immediate inclusion of prioritised interventions into the WHO NCD agenda could catalyse action, reduce health inequities, and strengthen the overall global response to chronic liver disease. Funding: Novo Nordisk and Echosens.