| Strategic International Session2（S）(JSH) |
| Fri. November 1st 9:30 - 12:00 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Change of nomenclature from NAFLD to MASLD: from epidemiology to clinical outcomes | |||
| Bilal Hameed | |||
| Division of Gastroenterology, University of California | |||
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| Hepatology has recently embraced new terminology for what was previously termed NAFLD. Now under the umbrella of steatotic liver disease (SLD), the term metabolic dysfunction-associated steatotic liver disease (MASLD) replaces NAFLD, highlighting the disease's strong link with metabolic dysfunction and reducing the stigma associated with the terms "nonalcoholic" and "fatty." The new classification also introduces metabolic and alcohol-associated liver disease (MetALD) for individuals with MASLD who consume more alcohol than the defined limits. MASLD includes both metabolic dysfunction-associated steatosis (MASL), a non-progressive subtype, and metabolic dysfunction-associated steatohepatitis (MASH), a progressive subtype. Affecting 24% to 35% of the U.S. population, the prevalence of MASLD and associated fibrosis is rising alongside increasing rates of metabolic syndrome. Patients with "at-risk" MASH, defined by active steatohepatitis and stage 2 fibrosis or higher, face significantly increased risks of liver-related morbidity and mortality. Fibrosis progression is closely linked to adverse hepatic outcomes, including hepatic decompensation, which can lead to death or require liver transplantation. Effective screening, especially for moderate (F2) and higher fibrosis stages, is critical to differentiate patients at risk for cardiovascular mortality from those at risk for major adverse liver outcomes. Until recently, there has been limited knowledge about the long-term benefits and cost-effectiveness of fibrosis screening. To address this gap, the American Association for the Study of Liver Diseases (AASLD) issued new guidance in May 2023, advocating targeted liver fibrosis screening in at-risk populations. This approach employs cost-effective tools like the fibrosis-4 (FIB-4) index and vibration-controlled transient elastography (VCTE) for early detection. As of March 14, 2024, resmetirom became the first FDA-approved pharmacotherapy for MASH, following over two decades of research. Approved for treating adults with noncirrhotic MASH (F2-F3 fibrosis), resmetirom represents a landmark in managing this condition. The approval was based on the successful MAESTRO NASH Phase 3 trial in at-risk MASH patients. At present, patients with cirrhosis and those with early (F0-1) fibrosis are not recommended for resmetirom treatment. Noninvasive tests (NITs), with or without liver biopsy, are now essential for identifying candidates for resmetirom, monitoring safety, and assessing efficacy and treatment duration. Emerging data will likely refine patient selection and safety protocols moving forward. |
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Index Term 1: MASLD Index Term 2: MetALD and steatotic liver disease |
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