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More than 30% of people worldwide have metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease. This includes 65% of individuals with type 2 diabetes (T2D) and 75% of those with obesity, making it a pressing global health concern.
At the “Innere Medizin fachübergreifend — Diabetologie grenzenlos” congress held on February 7-8 in Munich, Germany, Dr. Martina Müller-Schilling, chair and director of the Department of Internal Medicine I at University Hospital Regensburg, highlighted the rising prevalence of MASLD due to the “obesity pandemic” in industrialized nations.
Understanding MASLD
MASLD is a liver disease associated with at least one cardiometabolic risk factor unrelated to alcohol consumption. It is particularly prevalent among individuals with T2D, who now face “new complications from a decade-long chronic and systemic disease,” according to Müller-Schilling.
The upcoming updated nomenclature for MASLD and metabolic dysfunction-associated steatohepatitis (MASH), expected in mid-2024, aims to emphasize the metabolic nature of the disease and reduce stigma linked to alcohol-related liver conditions.
Screening and Diagnosis
A targeted approach is recommended for identifying at-risk individuals, including:
- Patients with unexplained elevated liver enzymes
- Individuals with obesity and hypertension
- Adults with T2D
MASLD is often detected incidentally during routine checkups. Primary care screening typically involves ultrasound and liver enzyme tests. If cardiovascular risk factors and comorbidities such as T2D, hypertension, or obesity are present, additional tests like the Fibrosis-4 blood test and enhanced liver fibrosis test help assess fibrosis severity.
According to Müller-Schilling, fibrosis is a precancerous condition and is expected to become the leading reason for liver transplants within the next decade. However, early diagnosis and intervention can prevent disease progression.
Advances in Diagnosis and Treatment
Biomarker scores and elastography are useful tools for assessing liver stiffness and disease progression. However, microscopic features of MASLD, such as ballooning or lobular inflammation, require histological examination via liver biopsy.
A recent study published in Cell Metabolism assessed a blood test for MASLD/MASH in 700 participants from the United States and China. The study used a three-parameter (N3) biomarker panel and demonstrated high specificity (90%) in identifying patients with MASH, potentially reducing the need for liver biopsies.
Prevention Through Lifestyle Changes
Lifestyle interventions remain the first-line treatment for early-stage fibrosis (F0/F1). Studies suggest that reducing caloric intake by 500 kcal/day can improve fibrosis, though weight loss alone may not always be sufficient, as rebound weight gain can worsen fibrosis.
A 2024 study found that exercise is more effective than weight loss alone in managing MASH. The study examined the effects of a calorie-restricted diet combined with high-intensity exercise and reported significant improvements in liver health after 10 months. Although the sample size was small (24 participants), the findings support current guidelines recommending a combination of diet and exercise.
Emerging Therapies
In addition to lifestyle modifications, GLP-1 receptor agonists such as semaglutide are now incorporated into clinical obesity management. Other treatment options include:
- GLP-1 receptor agonists, coagonists, SGLT-2 inhibitors, metformin, or insulin for T2D
- Statins for dyslipidemia
- GLP-1 receptor agonists and bariatric procedures for obesity
A significant breakthrough came in early 2024 when the U.S. approved resmetirom, a thyroid hormone receptor beta agonist, for treating MASH. While promising, the drug is still awaiting approval from the European Medicines Agency.
Future Directions
Müller-Schilling emphasized the importance of targeted therapies for MASLD/MASH, highlighting the role of biomarkers in monitoring treatment response. She compared this approach to those used in oncology and gastroenterology, reinforcing the need for precision medicine in liver disease management.
Conclusion
MASLD is a growing public health challenge closely linked to the obesity and diabetes epidemics. Early diagnosis, lifestyle interventions, and emerging treatments offer hope for better management and prevention. As research continues to advance, personalized treatment strategies may revolutionize care for MASLD patients.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult a healthcare professional for diagnosis and treatment of MASLD or related conditions.
