METABOLIC dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is a condition characterised by the accumulation of fat in the liver in the presence of one or more cardiometabolic risk factors, such as type 2 diabetes or obesity, and without excessive alcohol consumption. MASLD is part of a broader spectrum of liver diseases, which includes steatosis (fat accumulation), metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH), fibrosis, cirrhosis, and MASH-related hepatocellular carcinoma (HCC).
Recent clinical guidelines from the European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes (EASD), and the European Association for the Study of Obesity (EASO) provide updated recommendations for diagnosing, preventing, and treating MASLD. These guidelines emphasise early detection through case-finding strategies that target individuals with cardiometabolic risk factors, abnormal liver enzymes, or signs of liver fat accumulation. Blood-based tests, such as the fibrosis-4 index, and imaging techniques, such as transient elastography, are recommended to assess liver fibrosis, which predicts liver-related outcomes.
The management of MASLD primarily revolves around lifestyle changes, including weight loss, a healthy diet, regular physical activity, and minimising alcohol consumption. For those with type 2 diabetes or obesity, incretin-based therapies such as semaglutide or tirzepatide may be beneficial. Bariatric surgery is also an option for individuals with obesity and MASLD.
For non-cirrhotic MASH patients with significant liver fibrosis, the use of the novel medication resmetirom has shown positive results in reducing liver inflammation and fibrosis. However, there is no targeted pharmacotherapy for cirrhosis at this stage. In advanced cases, management includes metabolic drug adjustments, nutritional support, monitoring for complications, and potentially liver transplantation.
MASLD has emerged as the most common chronic liver disease worldwide, with a significant impact on cardiovascular health, kidney function, and cancer risk, highlighting the urgent need for proactive medical and policy interventions.
Katie Wright, EMJ
Reference
European Association for the Study of the Liver; European Association for the Study of Diabetes; European Association for the Study of Obesity. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD): Executive Summary. Diabetologia. 2024;DOI:10.1007/s00125-024-06196-3.
