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The Hidden Dangers of Fatty Liver Disease & MASH

MD Newsline

Release Date: 05/28/2025

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In this episode of MD Newsline, hepatologist Dr. Steven Flamm (Northwestern Medicine) demystifies the spectrum of metabolic-associated fatty liver disease—from the highly prevalent MASLD (metabolic-associated steatotic liver disease) to its inflammatory form, MASH (metabolic-associated steatohepatitis). Dr. Flamm details who is at risk, why only a subset progress to fibrosis and cirrhosis, and how clinicians can intervene early with lifestyle, pharmacologic, and procedural tools. He also reviews the first FDA-approved therapy (resmetirom), the promise of GLP-1 agents, and why cardiovascular and cancer screening remain paramount for these patients.

Episode Highlights:

Defining MASLD and MASH Dr. Flamm explains the reclassification of fatty liver disease into MASLD (metabolic-associated steatotic liver disease) and MASH (metabolic-associated steatohepatitis). MASLD is widespread, affecting nearly 100 million Americans, but only a fraction progress to MASH and fibrosis. Diagnosis relies on imaging for liver fat and biopsy to assess inflammation and fibrosis stage.

Risk Factors and Disease Progression Obesity, type 2 diabetes, and dyslipidemia are the key drivers of MASLD and MASH. Dr. Flamm highlights the importance of early identification and the role of insulin resistance and genetic predisposition in disease progression. He also addresses the need for better awareness of the cardiovascular and oncologic risks associated with fatty liver disease.

Treatment Options and Emerging Therapies Weight loss remains the cornerstone of treatment, with a target of 8–10% reduction in body weight to reverse liver inflammation and fibrosis. Dr. Flamm reviews current options including GLP-1 receptor agonists, bariatric procedures, and the newly approved resmetirom for MASH. He also emphasizes that statins are safe and effective in these patients despite outdated concerns.

Multidisciplinary Management and Patient Monitoring Dr. Flamm outlines a comprehensive care strategy involving endocrinologists, nutritionists, cardiologists, and hepatologists. He recommends regular cardiovascular screening and bi-annual ultrasounds for cirrhotic patients to detect hepatocellular carcinoma early. Patients with alcohol use should be counseled to abstain to prevent further liver damage.

Future Directions in Fatty Liver Research Genetic and gut-liver axis research is paving the way for personalized medicine in MASLD and MASH. Dr. Flamm anticipates more targeted antifibrotic therapies and combination regimens to emerge, transforming the treatment landscape over the next decade.

Key Takeaway:

Effective management of MASLD/MASH hinges on early identification of at-risk patients, aggressive control of metabolic drivers, and use of evolving pharmacologic options—while never losing sight of the dominant threats of cardiovascular disease and extra-hepatic cancers.

Resources:

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Connect with Dr. Steven Flamm https://www.rushu.rush.edu/faculty/steven-flamm-md-faasld-facg


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