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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2026; 32(2): 114097
Published online Jan 14, 2026. doi: 10.3748/wjg.v32.i2.114097
Published online Jan 14, 2026. doi: 10.3748/wjg.v32.i2.114097
Noninvasive strategies for metabolic dysfunction-associated steatotic liver disease assessment and referral in Japan
Yoshihiro Kamada, Department of Advanced Metabolic Hepatology, Graduate School of Medicine, The University of Osaka, Suita 565-0871, Osaka, Japan
Yoshio Sumida, Graduate School of Healthcare Management, International University of Healthcare and Welfare, Tokyo 107-8402, Japan
Hirokazu Takahashi, Division of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, Saga 849-8501, Japan
Hirokazu Takahashi, Liver Center, Saga University Hospital, Saga 849-8501, Japan
Hiroshi Ishiba, Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
Miwa Kawanaka, Department of Gastroenterology and Hepatology, Okayama University, Okayama 700-8558, Japan
Toshifumi Tada, Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Masato Yoneda, Kento Imajo, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Kento Imajo, Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
Yuya Seko, Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Hideki Fujii, Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
Atsushi Nakajima, Department of Gastroenterology and Hepatology, International University of Healthcare and Welfare, Shizuoka 413-0012, Japan
Author contributions: Kamada Y, Sumida Y, Takahashi H, Ishiba H, Kawanaka M, Tada T, Yoneda M, Imajo K, Seko Y, Fujii H, and Nakajima A contributed to drafting the manuscript and reviewing and editing the manuscript; Kamada Y, Sumida Y, Takahashi H, and Fujii H contributed to conceptualization; Kamada Y was responsible for funding acquisition; Takahashi H and Nakajima A supervised the study; All authors read and approved the final manuscript.
Supported by Japan Society for the Promotion of Science KAKENHI, No. 25K11274.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hirokazu Takahashi, MD, PhD, Professor, Division of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan. takahas2@cc.saga-u.ac.jp
Received: September 11, 2025
Revised: November 3, 2025
Accepted: November 25, 2025
Published online: January 14, 2026
Processing time: 123 Days and 3.5 Hours
Revised: November 3, 2025
Accepted: November 25, 2025
Published online: January 14, 2026
Processing time: 123 Days and 3.5 Hours
Core Tip
Core Tip: MASLD is highly prevalent, progressing to MASH, fibrosis, cirrhosis, and hepatocellular carcinoma. Although liver biopsy is traditional, noninvasive tests (NITs) such as the fibrosis-4 index, enhanced liver fibrosis test, Mac-2-binding protein glycosylation isomer, type IV collagen 7S, cytokeratin-18 fragments, and imaging (elastography/magnetic resonance elastography) now enable accurate and accessible assessment of liver fibrosis. This review summarized expert consensus on the appropriate use of NITs in Japan, providing evidence-based referral strategies and practical algorithms for primary care and non-hepatologists. Delphi panel results confirmed the utility of NITs but also highlighted the need for further longitudinal studies to establish their prognostic value.