Hierarchical diagnosis and treatment pathway and multidisciplinary collaborative intelligent holistic management protocol for metabolic dysfunction-associated fatty liver disease within the Hepatology Specialty Alliance framework： An integrated traditional Chinese and Western medicine approach

Metabolic dysfunction-associated fatty liver disease （MAFLD） has become the leading cause of chronic liver disease in China， and it is closely intertwined with various metabolic disorders such as cardiovascular diseases and type 2 diabetes， collectively constituting a complex systemic condition. Current clinical practice still faces the challenges including non-standardized application of screening and risk stratification tools， and a lack of multidisciplinary collaboration mechanisms， which lead to inefficient holistic management of MAFLD and significant variability in prognosis. To address these challenges， this study developed a scientific， systematic， and operable clinical pathway for hierarchical diagnosis and treatment and holistic management of MAFLD based on the Hepatology Specialty Alliance framework. The core components of this pathway include the following aspects： establishing dual-dimensional diagnostic criteria based on imaging and metabolic abnormalities； defining the non-invasive fibrosis-4 index as the key node for initial risk stratification within the alliance， combined with liver stiffness measurement for precise patient triage； systematically formulating bidirectional referral indications and collaborative workflows among hepatology， endocrinology， cardiology， and nutrition departments； integrating evidence-based pharmacological therapy and traditional Chinese medicine adjuvant strategies on the basis of intensified lifestyle intervention. Furthermore， this study prospectively proposes a framework for an intelligent management platform characterized by data-driven decision-making， smart early warning， and whole-course follow-up. This clinical pathway aims to provide standardized MAFLD management tools for healthcare institutions at all levels within the Hepatology Specialty Alliance system， and it seeks to promote a shift from the model of “diagnosis and treatment of a single liver disease” to a paradigm of “integrated management of multi-system comorbidities”， in order to reduce the risk of liver diseases and cardiovascular endpoint events and improve the long-term prognosis of patients.