Editorial: Pharmacological and Nutritional Approaches to Metabolic Associated Fatty Liver Disease: A Step Towards Achieving SDG 3

Mahmut Bodur¹Bojana B Vidovic²Anastasios Nikolaou³Birsen Yilmaz^4,5*

• ¹Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara University, Ankara, Türkiye
• ²Department of Bromatology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
• ³Laboratory of Applied Microbiology & Biotechnology, Department of Molecular Biology & Genetics, Democritus University of Thrace, Alexandroupolis, Greece
• ⁴Department of Biological Sciences, Tata Institute of Fundamental Research, Hyderabad, India
• ⁵Advanced Research Unit on Metabolism, Development and Ageing (ARUMDA), Tata Institute of Fundamental Research, Hyderabad, India

Metabolic-Associated Fatty Liver Disease (MAFLD) has rapidly become a leading global health challenge of the 21st century, currently affecting around a quarter of the adult population worldwide (Younossi vd., 2025). As a systemic metabolic disorder, MAFLD is strongly associated with obesity and type 2 diabetes mellitus (T2DM), as well as an increased risk of cardiovascular mortality (Zhou vd., 2023). Addressing the MAFLD epidemic is not only a clinical necessity, but also a critical step towards achieving United Nations Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being at all ages (United Nations, 2015). In this context, the present Research Topic, titled "Pharmacological and Nutritional Approaches to Metabolic-Associated Fatty Liver Disease", brings together five studies that collectively highlight emerging therapeutic perspectives.The management of MAFLD remains largely reliant on lifestyle and nutritional modifications as the most broadly applicable intervention strategies. In this context, Yu et al. (2025) provide important evidence from a large hospital-based cohort in China, examining the association between sugarsweetened beverage (SSB) consumption and MAFLD risk among individuals with type 2 diabetes mellitus. In 3,305 patients, weekly SSB intake was analysed using multivariable logistic regression models. Compared with those consuming none or fewer SSB per week, individuals consuming 3-4 bottles weekly had significantly higher odds of MAFLD (adjusted OR=1.72,p=0.004), with a clear dose-response relationship across higher intake categories (p for 32 trend < 0.001). These associations remained robust after adjustment for major demographic and 33 metabolic covariates. Mechanistically, the findings support a role for excessive SSB intake in hepatic 34 de novo lipogenesis and metabolic dysregulation, highlighting SSB reduction as a practical, low-cost 35 target for nutritional counselling. Notably, the authors emphasise regional variability in SSB 36 consumption trends across Asia, underscoring the importance of population-specific dietary risk 37 assessment. 38The real-world clinical and economic relevance of lifestyle-based interventions is further 39 demonstrated by Polignano et al. (2025), who evaluated a multidisciplinary, kinesiology-supervised 40 lifestyle programme implemented in routine care for adults with metabolic dysfunction-associated 41 steatotic liver disease (MASLD) in Italy. This pre-post observational study included 27 adults (≥18 42 years) with ultrasound-confirmed MASLD who completed a 12-month intervention combining 43 thrice-weekly supervised aerobic and resistance exercise with individualized dietary counselling. 44Exercise sessions were delivered in a hospital-affiliated gym under continuous professional 45 supervision, while nutritional guidance was provided by a dietitian and tailored to individual 46 metabolic needs. The programme resulted in significant improvements in health-related quality of life 47 (QALY gain: 0.081, 95%CI: 0.001-0.161), reductions in systolic and diastolic blood pressure 48 (-5.6/-3.7 mmHg; p=0.05 and p=0.03), and favourable liver-related outcomes, including a shift 49 toward lower ultrasound steatosis grades (p=0.007) and declines in serum aminotransferases 50 (p<0.01). Importantly, cost-utility analysis indicated a favourable incremental cost-effectiveness 51 ratio (€17,778 per QALY), well below accepted willingness-to-pay thresholds, supporting supervised 52 lifestyle programmes as a cost-effective and scalable component of MASLD management. 53In addition to lifestyle factors, the systemic complexity of MAFLD necessitates a broader 54 understanding of its interactions with endocrine and metabolic pathways. In this context, Xiong et al. 55 (2025) conducted a systematic review and meta-analysis examining the association between thyroid 56 hormone profiles and MAFLD. Rather than relying on clinical thyroid diagnoses, abnormal thyroid 57 function was defined based on circulating hormone parameters, including TSH, FT3, FT4, TT3, and 58 TT4. The pooled analysis showed that individuals with MAFLD had significantly higher TSH levels 59 (SMD = 0.02, 95% CI: 0.01-0.03) and markedly lower FT4 levels (SMD = -0.41, 95%CI: -0.42 to 60 -0.40), alongside higher FT3 and TT3 and lower TT4 concentrations. Collectively, these robust 61 associations indicate a higher likelihood of hepatic steatosis in individuals with altered thyroid 62 hormone profiles and support the integration of thyroid function assessment into MAFLD risk 63 stratification conventional metabolic markers. 64There increasing focus on targeting the gut-liver axis in emerging therapeutic strategies, as it is 65 recognised as a critical modulator of metabolic and inflammatory processes in MAFLD. In this 66 context, Teofilović et al. (2025) assessed the therapeutic potential of the probiotic strain 67 Lactobacillus helveticus BGRA43 using a high-fat diet-induced obesity model in male C57BL/6J 68 mice. They found that oral administration of this probiotic strain significantly reduced hepatic lipid 69 accumulation and restored gut microbiota diversity. By emphasising the role of functional foods and 70 so-called 'psychobiotics' in modulating systemic inflammation and metabolic homeostasis, this study 71 highlights the potential of accessible nutraceutical interventions. Such approaches are particularly 72 relevant for advancing health equity, especially in settings where access to advanced pharmacological 73 therapies remains limited. 74A study has identified new diagnostic and therapeutic targets for MAFLD. Wang et al. (2025)