Addressing the burden of steatotic liver disease: The role of transient elastography: Correspondence to editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017-2023”

Article information

Clin Mol Hepatol. 2025;31(2):e180-e182

Publication date (electronic) : 2025 February 13

doi : https://doi.org/10.3350/cmh.2025.0125

Donghee Kim^,1, Pojsakorn Danpanichkul², Karn Wijarnpreecha^3,4, George Cholankeril⁵, Rohit Loomba⁶, Aijaz Ahmed¹

¹Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA

²Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

³Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA

⁴Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA

⁵Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

⁶Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, CA, USA

Corresponding author : Donghee Kim Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94304, USA Tel: +1-650-497-9261, Fax: +1-650-498-5692, E-mail: dhkimmd90@gmail.com

Editor: Han Ah Lee, Chung-Ang University College of Medicine, Korea

Received 2025 February 4; Accepted 2025 February 12.

Dear Editor,

We appreciate Dr. Ming-Hua Zheng and colleagues’ valuable comments regarding our recently published paper “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017-2023” [1,2]. The editorial adeptly highlights the growing concerns about steatotic liver disease (SLD) and its connection to cardiometabolic abnormalities such as obesity and diabetes. The authors convincingly advocate for incorporating Vibration-Controlled Transient Elastography (VCTE) into routine clinical practice as a non-invasive, effective method for evaluating and managing SLD.

The growing burden of SLD is an urgent public health concern that cannot be overlooked. The nomenclature for SLD has transitioned from nonalcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease (MASLD) [3], and our paper has adopted this new one [1]. The age-adjusted prevalence of SLD in the United States is 35.0%, with MASLD accounting for 31.9%, metabolic dysfunction and alcohol-related steatotic liver disease for 2.2%, and alcohol-related liver disease for 0.8% [1]. The high prevalence of SLD, particularly MASLD, underscores the need for effective diagnostic and management strategies. As the editorial points out, SLD is more than a localized liver condition; it carries significant cardiovascular risks and long-term adverse health consequences [4,5]. The increasing prevalence of obesity and related metabolic disorders exacerbates this issue, necessitating more robust screening and management protocols. SLD constitutes a substantial portion of global chronic liver disease cases [6], and its silent progression often leads to severe outcomes if left undetected. Recognizing these challenges necessitates proactive measures to improve diagnostic and therapeutic strategies.

VCTE is a valuable tool for assessing liver stiffness and fat content, providing critical insights into the severity of SLD. The point made by the authors regarding the capability of VCTE to differentiate varying degrees of fibrosis and steatosis is of particular significance. This dual functionality allows healthcare providers to perform more precise risk stratification and tailor interventions accordingly, leading to more personalized patient care. Moreover, VCTE’s non-invasive nature allows for repeat measurements with minimal patient discomfort, addressing the increasing need for real-time monitoring of SLD. This aspect is particularly crucial for managing chronic conditions like SLD that require ongoing surveillance [7]. While highlighting VCTE’s benefits, the editorial appropriately acknowledges existing barriers to its widespread implementation. These include high costs, the need for trained personnel, and potential variability in results among operators [2]. Addressing these challenges is vital for maximizing the opportunities and potential presented by VCTE. Investing in training programs and establishing standardized operating procedures can improve the consistency and reliability of results among healthcare providers. Collaboration with technology developers to create cost-effective models can also enhance accessibility, enabling broader patient populations to benefit from this innovative tool. Engaging health systems in developing strategies for VCTE integration can facilitate smoother transitions from traditional diagnostic methods. The integration of VCTE into population-based initiatives is critical for effectively managing SLD. As mentioned, continuous monitoring through VCTE can help identify at-risk populations [7,8] and provide a base for public health efforts to prevent liver disease progression. Public health programs that increase awareness of metabolic risk factors associated with SLD and encourage routine check-ups with VCTE are crucial for early detection and preventative measures.

Furthermore, using VCTE in epidemiological research can provide crucial insights into the trends and prevalence of SLD across diverse populations. This is essential for guiding healthcare policies and resource allocation, ensuring interventions are directed toward the communities most affected by SLD. The authors rightly encourage further research and collaboration in this area, emphasizing the need for an enhanced understanding of this growing epidemic. The call for more research on the long-term outcomes of patients diagnosed through VCTE is paramount [7,8]. Establishing large-multicenter studies could further validate the efficacy of VCTE in different demographics and clinical settings. Additionally, interdisciplinary collaborations involving hepatologists, endocrinologists, and primary care providers can promote comprehensive SLD management. Emphasizing lifestyle interventions alongside VCTE-based monitoring and treatment can foster integrated care models capable of addressing the multifaceted nature of SLD. Finally, targeted awareness campaigns for both patients and the public are crucial to highlight SLD risks and emphasize the importance of VCTE in maintaining liver health.

In conclusion, the editorial by Dr. Zheng and co-authors sheds light on the urgent need for proactive measures in managing SLD and positioning VCTE as a cornerstone in this endeavor. While challenges remain, improving VCTE accessibility and reliability offers a promising path forward. To mitigate the escalating burden of SLD and improve patient outcomes, healthcare providers should promote community awareness about SLD risk factors, encourage healthy lifestyle changes, and advocate for early detection of vulnerable populations.