ABSTRACT Metabolic dysfunction‐associated steatotic liver disease (MASLD) and obesity share common pathogenesis and are increasingly relevant in clinical care. This joint statement addresses the need for comprehensive guidance in Taiwan for MASLD patients with obesity. The Gastroenterological Society of Taiwan, the Taiwan Association for the Study of the Liver, and the Taiwan Medical Association for the Study of Obesity conducted an evidence‐based review, integrating epidemiological data, clinical trial outcomes, and expert consensus to develop position statements covering diagnosis, disease burden, pathogenesis, surveillance, and therapeutic strategies. MASLD prevalence in Taiwanese adults is 30%–45%, reaching 60%–70% in individuals with obesity, with similar high prevalence in children and adolescents. Obesity accelerates hepatic and extrahepatic disease progression, including cirrhosis, hepatocellular carcinoma, and cardiovascular complications. Lifestyle interventions, glucagon‐like peptide‐1 receptor agonists, resmetirom, and bariatric surgery demonstrate efficacy in improving hepatic and metabolic outcomes. Risk stratification using noninvasive tools such as Fibrosis‐4 and vibration‐controlled transient elastography effectively guides referral and management. A multidisciplinary, precision‐based approach, integrating lifestyle modification, pharmacotherapy, surgical options, and risk stratification, is essential for effective MASLD management in patients with obesity, while research into artificial intelligence‐driven biomarkers, gut microbiota modulation, and genetic factors represents future directions.
ABSTRACT Ammonia is a nitrogenous molecule which is primarily generated in the gastrointestinal tract. The neurotoxicity of ammonia plays a critical role in the liver's regulation of circulating ammonia levels. In liver disease, an increase in blood ammonia has been long implicated in the pathogenesis of hepatic encephalopathy (HE), a neurological complication of liver disease. However, the clinical value of measuring plasma ammonia in patients with cirrhosis remains controversial. This dilemma was the subject of a debate held at the International Society of Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) meeting in St‐Paulin, Québec, Canada in October 2025. This review illustrates the pros & cons of measuring plasma ammonia in the management of patients with cirrhosis.
