Fatty Liver Has No Alarm. Taiwan Wants FIB-4 to Be One

Key Takeaway

Three major Taiwanese medical societies have issued a joint position statement warning that fatty liver disease affects 30%-45% of adults and 60%-70% of people with obesity. They endorse lifestyle change, GLP-1 receptor agonists, resmetirom, and bariatric surgery as effective treatments, and recommend simple noninvasive tests, the FIB-4 score and liver stiffness scans, to find the patients in real danger.

The Silent Organ in the Room

He comes in for a knee complaint. He is 48, carries extra weight around his middle, and his blood sugar has been creeping up for years. Nobody asks about his liver because his liver has never complained. That is the problem. The liver has almost no pain fibers in its tissue. It can fill with fat, become inflamed, and begin to scar while the person feels completely normal.

In Taiwan, that quiet scenario is now the rule rather than the exception. Metabolic dysfunction-associated steatotic liver disease, or MASLD (the new name for what most people still call fatty liver disease), affects 30%-45% of Taiwanese adults, and 60%-70% of people living with obesity, with similarly high rates in children and adolescents^[1].…