Identification and Management of MASLD: Primary Care Tips

Dr Kevin Fernando discusses the identification and management of people with MASLD in primary care.
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-- TRANSCRIPT --
In this podcast, I'm going to talk about the renaming of NAFLD, nonalcoholic fatty liver disease, to MASLD, metabolic dysfunction-associated steatotic liver disease, and how we might identify and manage people with MASLD in primary care.
I hope to convince you about the gravity of a diagnosis of MASLD, the need to identify individuals at high risk for progressive liver disease, and appropriate interventions to prevent the debilitating consequences of advanced liver disease.
During summer 2023, NAFLD was renamed by international consensus to reduce the stigma associated with nonalcoholic fatty liver disease and also to facilitate a shift towards prevention, proactive case finding, and early identification of progressive liver fibrosis.
How do we define MASLD? MASLD encompasses individuals with evidence of hepatic steatosis - for example, found incidentally on an abdominal ultrasound scan and at least one cardiometabolic risk factor.
These include a BMI, or body mass index, of over 25, or 23 if from a high-risk ethnic group, such as South Asians; or a waist circumference over 94 cm in men (over 90 cm if that man is from a high-risk ethnic group) or over 80 cm in women of all ethnicities.
Additionally, other cardiometabolic risk factors are an A1c between 42 and 47 mmol/mol, or 6% and 6.4%; anyone with established type 2 diabetes; blood pressure ≥ 130/85 mm Hg; and anyone on established antihypertensive drug treatment.
We also need to look at dyslipidemia as a cardiometabolic risk factor, such as plasma triglyceride levels ≥ 1.7 mmol/L, established lipid-lowering treatment, a plasma HDL cholesterol level 1.0 mmol/L, or again, established lipid-lowering treatment.
These are all standard cardiometabolic risk factors. You can see that MASLD is primarily a metabolic disease. It's the liver's manifestation of the metabolic syndrome.
Furthermore, MASH, metabolic dysfunction-associated steatohepatitis, replaces NASH, or nonalcoholic steatohepatitis. MASH is the more inflammatory stage of MASLD defined by inflammation of hepatocytes. This stage is significant because MASH carries a risk for progression to fibrosis, cirrhosis, and even hepatocellular carcinoma.
How common is MASLD? Since the 1970s, mortality has fallen from vascular disease, respiratory disease, and even cancer, whereas mortality has risen fourfold from liver disease. The main causes of liver disease over those years are, of course, alcohol misuse, chronic viral hepatitis, and now MASLD and MASH, driven by the obesity pandemic.
MASLD is actually now the most common liver disorder in Western countries, affecting up to one third of adults globally and up to 90% of people living with obesity or type 2 diabetes. Sadly, MASH is the fastest-growing indication for liver transplantation in Western countries. What we need to do in primary care is to prevent the progression of MASLD to the more inflammatory stage of MASH.
Transcript in its entirety can be found by clicking here:
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