Metabolic Dysfunction-associated Steatotic Liver Disease in Romania: A Multidisciplinary Position Paper on Prevalence, Clinical Spectrum, Prevention, Screening and Management

Abstract

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally and a rising cause of cirrhosis, hepatocellular carcinoma, liver transplantation, cardiovascular events and impaired quality of life. In Romania, a 30-33% adult prevalence would correspond to approximately 4.5–5.1 million adults with MASLD, including an estimated 225,000–410,000 with the progressive phenotype of metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis. In May 2026, a national multidisciplinary initiative was launched to support a coordinated response aligned with the World Health Assembly. draft resolution on steatotic liver disease.

Methods: The 3rd Romanian Forum of Metabolic Hepatology (Bucharest, 12 March 2026), co-hosted by Romanian Society of Gastroenterology and Hepatology (SRGH) and Romanian Association for Liver Diseases (RoALD), convened hepatology, primary care, metabolic, cardiovascular, renal, respiratory, ENT, transfusion medicine, public health, policy and patient representatives. Evidence, Romanian estimates, EASL-EASD-EASO 2024 guidance and policy documents were reviewed and refined into ten consensus statements. Results: The statements address burden, nomenclature, policy gaps, MASLD phenotypes, metabolic dysfunction and alcohol-associated liver disease (MetALD), integration within the cardio-reno-hepato-metabolic/non-communicable diseases framework, fibrosis-4 index (FIB-4) based case-finding, cross-specialty prescribing, a Romanian clinical care pathway and a national action plan including quality-of-life outcomes and access to EU-approved resmetirom for eligible adults with non-cirrhotic MASH and F2-F3 fibrosis. Conclusions: This position paper provides a Romanian framework for MASLD prevention, detection and care, requiring coordinated action by professional societies, health authorities, the Romanian National Health Insurance Agency (CNAS), primary care, patient organisations and civil society.