| Strategic International Session2（S）(JSH) |
| Fri. November 1st 9:30 - 12:00 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Management of MASLD in the Real-World Setting | |||
| Calvin Q. Pan | |||
| Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine | |||
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| Metabolic Associated Steatotic Liver Disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is characterized by hepatic steatosis without significant alcohol consumption or other secondary causes. Managing MASLD in the real-world setting is challenging due to its strong ties to metabolic syndromes such as obesity, type 2 diabetes, dyslipidemia, and hypertension. Effective management involves patient-centered strategies, multidisciplinary care, and emerging therapeutic interventions. Early identification of MASLD in primary care is crucial but difficult due to its often asymptomatic nature. Regular screening of at-risk populations using non-invasive tools like ultrasound and FibroScan is recommended to detect early liver steatosis and fibrosis. Biomarkers and scoring systems, such as the FIB-4 index and the NAFLD fibrosis score, are invaluable for assessing disease severity and guiding referrals to hepatology specialists. The FibroScan-AST (FAST) score, combining liver stiffness measurement, controlled attenuation parameter, and serum AST levels, is emerging as a new tool for identifying patients at higher risk of significant fibrosis or steatohepatitis. Lifestyle modification is the cornerstone of MASLD management. Weight loss through dietary changes, increased physical activity, and behavioral modifications can significantly reduce hepatic fat content and improve liver histology. Structured weight management programs and the Mediterranean diet have shown efficacy in real-world studies. Pharmacological interventions are considered for patients who do not achieve adequate results through lifestyle changes alone or have advanced disease stages. The off-label use of pioglitazone, GLP-1 receptor agonists (e.g., liraglutide), and vitamin E has demonstrated favorable effects on liver histology in MASLD patients with diabetes or prediabetes. Resmetirom, an FDA-approved thyroid hormone receptor-Β agonist, promotes hepatic fat metabolism and prevents hepatic injury from lipotoxicity but lacks long-term safety data and did not show histological improvement in all participants. Managing comorbid conditions is integral to MASLD treatment. Tight glycemic control, lipid-lowering therapies, and antihypertensive medications are crucial for mitigating liver disease progression and reducing cardiovascular risks. Emerging therapies targeting metabolic and inflammatory pathways are under investigation, offering potential new treatments. In conclusion, managing MASLD in real-world settings demands a holistic approach, integrating lifestyle interventions, pharmacotherapy, and multidisciplinary care. Early detection, patient education, and continuous monitoring are pivotal for improving long-term outcomes. As research progresses, adopting new therapeutic options and personalized treatment strategies will further enhance the management of this complex and increasingly common liver disease. |
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Index Term 1: MASLD Index Term 2: management |
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