Plain language review: non-invasive screening for metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) in primary care.

Abstract

What is this summary about?Metabolic dysfunction–associated steatotic liver disease, or MASLD, and its severe form, metabolic dysfunction–associated steatohepatitis, or MASH, impose significant global burdens on patients and healthcare systems. It is important to identify people with MASLD and MASH, as these conditions can lead to serious health issues if untreated, like cirrhosis, liver failure, and liver cancer. Disease worsening also risks worsening non-liver-related conditions linked to obesity and metabolic dysfunction.Scientific society guidelines recommend using non-invasive tests in primary care to screen for MASLD and MASH risk, and support referral and treatment decisions. These guidelines recommend calculating the Fibrosis-4 Index score, which is based on age and blood tests. If scores are elevated, patients are recommended to undergo further testing for MASH and cirrhosis. Secondary tests include ultrasound elastography, magnetic resonance imaging techniques, or Enhanced Liver FibrosisTM blood-based test.Non-invasive tests may also be used to determine patient eligibility for treatment with resmetirom or semaglutide, approved therapies for MASH with advanced fibrosis without cirrhosis, and to assess treatment response. Wide-scale use of non-invasive tests in primary care could help identify people with MASLD and MASH risk, enabling timely treatment, slowing of disease worsening, and prevention of serious health complications and deaths.