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    What is new in the 2025 APASL guidelines for metabolic dysfunction-associated fatty liver disease?
    (AME Publishing Company, 2026) Pan, Ziyan; Örmeci, Necati; Chen, Jinjun; Ghazinian, Hasmik; Payawal, Diana; Eslam, Mohammed
    As the global epidemics of obesity and type 2 diabetes mellitus (T2DM) continue to rise, metabolic dysfunction associated fatty liver disease (MAFLD) has become the most common chronic liver disease globally. The Asia-Pacific region is particularly affected, accounting for a significant majority of global liver-related deaths (1). To address this, the Asian Pacific Association for the Study of the Liver (APASL) has released updated clinical practice guidelines in 2025 (2). This article is a commentary focusing on the key changes and new recommendations within those guidelines, which were published in Hepatology International (2). Recognizing the limitations of the exclusionary diagnostic criteria for non-alcoholic fatty liver disease (NAFLD) and emphasizing the key role of metabolic dysfunction in disease pathogenesis, the introduction of the MAFLD definition in 2020 was a milestone in disease research and clinical practice (3-5). This shift reflects a significant evolution in our understanding of the disease, moving away from a diagnosis of exclusion towards one of inclusion based on metabolic dysfunction, recognizing the central role of metabolic factors and introducing the key concept of dual etiology, including alcohol consumption or coexisting liver diseases (6). Over the past 5 years, there have been significant advancements in understanding the disease, culminating in new knowledge, the first approved treatment, and the beginning of a new era of artificial intelligence (AI) with potential promise for hepatology. These changes stimulate the need for an updated document of the APASL guidelines for the diagnosis and management of MAFLD, which was recently released in 2025 (2). This updated guideline provides a comprehensive framework for addressing the growing burden of MAFLD in the Asia-Pacific region. This commentary aims to highlight the key aspects in this landmark document and touch on the main changes from the 2020 version (7).