Reply to correspondence 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):e221-e223

Publication date (electronic) : 2025 March 4

doi : https://doi.org/10.3350/cmh.2025.0226

Jeayeon Park, Su Jong Yu

Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Corresponding author : Su Jong Yu Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2228, Fax: +82-2-743-6701, E-mail: ydoctor2@snu.ac.kr

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

Received 2025 February 25; Accepted 2025 February 26.

Dear Editor,

We sincerely appreciate the insightful and comprehensive response from Dr. Kim to our editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017-2023” as discussed in their study [1,2]. Their study highlighted the importance of lifestyle modifications and a multidisciplinary approach, as it demonstrated an increase in the number of steatotic liver disease (SLD) patients progressing to advanced fibrosis during the COVID-19 pandemic [3].

The rise in SLD is not just a concern in the United States but a worldwide issue [4,5]. However, beyond the liver community, there is a lack of attention to SLD from other health organizations, including the World Health Organization, and no established public health strategies to address it [6-8]. Recently, a large, globally diverse multidisciplinary panel reached a high level of consensus on research priorities for fatty liver disease [7]. Adopting this multidisciplinary consensus-based research priority agenda is expected to bring a transformative change in addressing fatty liver disease, mitigating its individual and societal burdens, and proactively altering its natural course through prevention, diagnosis, treatment, and care.

The early detection of SLD, including metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and alcohol-related SLD, and alcohol-related liver disease (ALD), is challenging because symptoms typically do not appear until the disease has progressed to advanced stages, such as liver cirrhosis or hepatocellular carcinoma [9,10]. Once symptoms manifest, treatment options become significantly limited due to irreversible liver damage and disease progression. This challenge contributes to the growing global disease burden and increases the risk of underestimating the number of undiagnosed SLD patients. If these undiagnosed cases remain unaddressed, the number of patients with advanced liver disease could rise sharply, potentially leading to a public health crisis. As demonstrated in the study by Kim et al., while most healthcare resources were directed toward COVID-19, the overall prevalence of SLD did not increase, but the proportion of patients progressing to advanced fibrosis did [3]. Therefore, it is crucial to continuously monitor patients diagnosed with SLD to ensure they receive timely specialist intervention. Furthermore, identifying asymptomatic, undiagnosed SLD cases and implementing proactive management strategies are essential to reducing the global disease burden.

Since non-invasive tests (NITs) are expected to help address these challenges, many researchers are dedicated to developing highly effective NITs [11-14]. To ensure continuous monitoring and the identification of undiagnosed SLD patients, accessibility is crucial, particularly in everyday settings, making it easy to use and widely available. This approach is essential for reaching medically underserved populations across different racial and age groups, where SLD prevalence is likely underestimated and the risk of progression to advanced liver disease is higher. In this regard, we can benefit from the rapid advancements in digital technology, which are becoming increasingly prevalent across diverse racial and socioeconomic groups [15]. By integrating NITs with digital healthcare technology, simple screening can be conducted in everyday settings, allowing for the early identification of patients who require aggressive intervention and expert monitoring. Digital health platforms, such as mobile applications, can facilitate a personalized, multidisciplinary approach to patient care. Additionally, these platforms can serve as hubs for telemedicine, ensuring continuity of care for SLD patients even during future pandemics or other public health crises.

In conclusion, their research demonstrated not only an increase in SLD patients progressing to advanced liver disease during the COVID-19 pandemic but also differences in the prevalence of SLD subtypes across racial and ethnic groups. To address these challenges, they emphasized the importance of a multidisciplinary approach. Integrating NITs with digital health technology represents a pivotal opportunity to advance proactive SLD management, ensuring equitable healthcare access for both medically underserved populations and the general population. Furthermore, this approach will be critical in maintaining uninterrupted care during future pandemics.