New Risk-Based Approach to Managing MASLD Highlights Fibrosis Regression Goals
A recent study published in The American Journal of Gastroenterology emphasizes the need for a risk-based approach to evaluating and managing metabolic dysfunction-associated steatotic liver disease (MASLD), including its progressive form, metabolic dysfunction-associated steatohepatitis (MASH). This approach aims to address the underlying metaboinflammatory state driving liver injury and to prioritize fibrosis regression as a key treatment objective.
MASLD, often linked to obesity and insulin resistance, is part of a cluster of noncommunicable diseases, including type 2 diabetes, hypertension, and cardiovascular disease. While simple steatosis carries a lower risk of progression, MASH is characterized by greater liver injury and inflammation, progressing to cirrhosis more frequently. As fibrosis increases, so does the risk of cirrhosis-related complications, making fibrosis regression critical in managing MASLD.
“The goal of treatment of MASLD/MASH [is] to improve the metaboinflammatory state, i.e., the root cause of the liver disease, and to prevent fibrosis progression to cirrhosis,” the study authors stated.
The approval of resmetirom for MASH with fibrosis and the expanded use of glucagon-like peptide-1 receptor agonists for obesity and type 2 diabetes highlight the growing importance of addressing liver health in obese patients. With the rising demand for liver care, the authors stress that management should incorporate both the liver-specific and systemic metabolic risks these patients face.
The study proposes a pragmatic and holistic framework for managing MASLD. This approach integrates liver-specific therapies with broader strategies to reduce the risk of metabolic comorbidities. “Patients with MASLD also have multiple metabolic comorbidities which represent competing threats to life,” the authors noted, emphasizing the need for a comprehensive care model.
The findings underscore the importance of individualized, multidisciplinary care in managing this complex disease.
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
