Liver Lineup: Managing MASLD and MASH Amid Limited Awareness, Overlapping Risk Factors

In this episode of Liver Lineup: Updates and Unfiltered Insights, Nancy Reau, MD, and Kimberly Brown, MD, turn their attention to metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction–associated steatohepatitis (MASH), conditions that now dominate hepatology clinics but continue to pose major diagnostic and therapeutic challenges. As new drugs enter the clinic and others advance through the pipeline, the hosts explore what meaningful progress looks like in a disease space defined by heterogeneity, comorbidities, and ongoing uncertainty around long-term outcomes.

The conversation opens with reflections on the transition from NAFLD/NASH to MASLD/MASH. Reau and Brown discuss how the updated terminology better captures the metabolic underpinnings of the disease and may help reduce stigma, while acknowledging that changing nomenclature alone does not solve longstanding issues around diagnosis, risk stratification, or patient engagement. They emphasize that many patients with advanced disease are still being identified late in their clinical course.

A central theme of the episode is how clinicians should think about treatment in MASH today. The hosts discuss the significance of having a therapy available for this patient population and what that means for hepatology practice. They underscore the importance of appropriate patient selection, fibrosis assessment, and setting realistic expectations around treatment goals, particularly given the complexity and heterogeneity of the disease.

Reau and Brown also address the role of weight loss and metabolic management in MASLD and MASH. They discuss how improvements in metabolic parameters can translate into liver-related benefits, while noting that sustained lifestyle change remains difficult to achieve and maintain. Pharmacologic approaches that support weight loss are discussed in the context of their broader metabolic effects, rather than as liver-specific therapies.

The episode concludes with a discussion of system-level challenges, including underdiagnosis, inconsistent use of noninvasive testing, and limited awareness outside of hepatology. As MASLD becomes an increasingly common cause of advanced liver disease, the hosts stress the need for better collaboration across specialties and clearer pathways for identifying patients who would benefit from referral and treatment.

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.