Editorial: Pharmacological and nutritional approaches to metabolic associated fatty liver disease: a step towards achieving SDG 3

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