A Holistic and Risk-Based Approach to Managing MAFLD and MASH
A new management framework for metabolic dysfunction-associated steatosis and steatohepatitis (MASLD/MASH) offers a pragmatic, risk-based strategy for clinicians dealing with the complexities of these liver diseases, which often coexist with obesity and other metabolic comorbidities.
MASLD, a liver disease primarily caused by obesity and insulin resistance, can progress to MASH, a more severe, histologically active form. MASH is characterized by increased inflammation and liver injury, which accelerates fibrosis and leads to cirrhosis. The treatment of MASLD and MASH aims to improve the underlying metaboinflammatory state and prevent further liver damage, with a particular focus on halting fibrosis progression. For patients with existing cirrhosis, additional interventions are necessary to manage portal hypertension-related complications.
Recent advances, such as the approval of resmetirom for MASH with fibrosis and the use of glucagon-like peptide-1 receptor agonists in obesity and type 2 diabetes, have drawn greater attention to these conditions. With obesity-related liver diseases becoming more common, a comprehensive and coordinated approach is essential. This approach must address the full spectrum of risks faced by patients with MASLD, not only liver disease but also associated conditions such as cardiovascular disease, chronic kidney disease, and hypertension.
The new framework emphasizes the importance of assessing and managing the entire patient’s risk profile, offering a holistic view of care that integrates liver disease treatment with the management of metabolic comorbidities. As the demand for liver assessments grows, particularly in obese individuals, this approach provides an accessible, practical model for improving outcomes in patients at high risk for both liver and metabolic complications, the authors concluded.
Reference
Shah N, Sanyal AJ. A pragmatic management approach for metabolic dysfunction-associated steatosis and steatohepatitis. Am J Gastroenterol. 2025;120(1):75-82. doi:10.14309/ajg.0000000000003215
