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November 2025
In this insightful session from the GHAPP MASLD Community Network, Alison Moe, PA-C, dives into the complex and often misunderstood relationship between alcohol use and metabolic dysfunction–associated steatotic liver disease (MASLD). Drawing from clinical experience, Alison explains why accurately screening, quantifying, and discussing alcohol consumption with patients is essential to understanding disease progression, treatment eligibility, and overall liver health. She outlines how continued alcohol use can alter liver function tests (LFTs), confound noninvasive test results, and affect candidacy for emerging MASH pharmacotherapies. Viewers will learn how to approach sensitive conversations about drinking habits without stigma, interpret AASLD alcohol threshold guidelines, and apply effective counseling strategies for patients with combined alcohol-related and metabolic liver disease. Alison also discusses the role of PEth urine testing, lifestyle counseling, and the importance of complete abstinence for those with advanced fibrosis. This educational talk provides clinicians with actionable insights to support patients in improving their metabolic and liver health through honest communication, behavioral change, and evidence-based management.
Related Podcast
MASH/MASLD in Type 2 Diabetes: Concurrent Medication Management
August 2025
In this video, April Morris, FNP, shares her expertise on the close connection between type 2 diabetes and fatty liver disease (MASLD/MASH). With over 16 years of experience in hepatology and endocrinology, she explains why patients with type 2 diabetes are at a higher risk of developing MASH due to shared risk factors like insulin resistance and obesity. April highlights how improving glycemic control, lowering A1C, weight loss, and lifestyle modifications can significantly reduce liver fat, inflammation, and fibrosis progression. She discusses the benefits of modern diabetes medications—including GLP-1 receptor agonists such as semaglutide and tirzepatide, SGLT2 inhibitors, and metformin—and how they not only improve blood sugar and weight management but also support liver, kidney, and heart health. Importantly, she notes that most diabetes medications remain safe for patients with liver disease unless advanced decompensated cirrhosis is present, where caution with metformin may be necessary due to lactic acidosis risk. April emphasizes that treating diabetes aggressively and reaching an A1C target around 7% can slow or even prevent progression of liver fibrosis. For APPs and providers, the takeaway is clear: effective diabetes management is one of the most powerful tools to improve liver outcomes.
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LFTs Demystified: A Practical Guide for APPs
June 2025
In this podcast episode, Michelle Barnett, PA-C, a liver disease specialist based in Colorado Springs, provides a clear and practical overview on demystifying liver enzyme abnormalities—particularly in the context of MASH (Metabolic Dysfunction–Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). With MASLD affecting nearly 1 in 4 American adults, understanding liver enzyme patterns is critical for early detection and effective management. Michelle breaks down commonly reported values from hepatic function panels—ALT, ALP (alkaline phosphatase), and total bilirubin—explaining what constitutes normal, acute, subacute, and chronic elevations. She walks through hepatocellular, cholestatic, mixed, and isolated hyperbilirubinemia patterns and what they reveal about underlying liver conditions such as MASH, alcohol-associated liver disease, viral hepatitis, biliary obstruction, and drug-induced liver injury. Whether you're a provider or a patient looking to better understand lab results, this episode delivers expert guidance on interpreting liver enzyme elevations to support more informed clinical decisions.
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Pharmacotherapy Review
July 2025
Join Christina Hanson, FNP-C, from South Denver Gastroenterology, as she provides an in-depth overview of the current pharmacologic treatment landscape for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH). This expert-led session explores the three cornerstones of MASH management—lifestyle and weight loss interventions, cardiovascular risk reduction, and liver-directed therapy—while highlighting the evolving role of GLP-1 receptor agonists and the recent FDA approval of resmetirom, the first medication indicated for adults with MASH and moderate to advanced fibrosis. Christina also discusses clinical trial data from MAESTRO-NASH, reviews historical agents like vitamin E and pioglitazone, and offers practical guidance on patient selection, safety considerations, and monitoring strategies. Whether you’re a GI provider, hepatology specialist, or primary care clinician managing fatty liver disease, this video provides valuable insights into how emerging therapies are shaping the future of MASH treatment.
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Monitoring for MASLD in Type 2 Diabetes
July 2025
In this episode of the GHAPP MASLD podcast series, Lavinia Iordache, PA-C from the University of Miami, shares expert guidance on monitoring metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes—a group at particularly high risk for disease progression. Lavinia explains the bidirectional relationship between MASLD and diabetes, highlighting the importance of early screening, timely non-invasive testing (NITs), and proactive management strategies to prevent advanced fibrosis and cirrhosis. She reviews essential tools such as FIB-4, ELF score, FibroScan, and MRI-PDFF, and offers clear recommendations on when to escalate care, refer to specialty clinics, or intensify follow-up. The discussion also covers the role of lifestyle interventions including the Mediterranean diet, intermittent fasting, exercise, and coffee consumption, as well as strategies to improve adherence despite psychosocial, cultural, or financial barriers. Lavinia emphasizes a multidisciplinary approach to managing MASLD and provides practical tips for tracking lifestyle changes, such as journaling and the use of the EDAS questionnaire. Whether you’re a GI, endocrinology, or primary care provider, this episode offers an actionable roadmap for reducing liver-related complications in patients with diabetes.
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Beyond Basic NITs: When is Liver Biopsy or Advanced Imaging
July 2025
In this episode, Brian Lam, PA, Associate Director of Research at Inova’s Liver and Obesity Research Program in Northern Virginia, explores the nuanced decision-making involved in going beyond basic non-invasive tests (NITs) for diagnosing and managing MASH (metabolic dysfunction-associated steatohepatitis). While FIB-4 and transient elastography are useful initial tools, Brian breaks down when and why clinicians should consider more advanced diagnostics—such as MR elastography (MRE), proton density fat fraction (PDFF), and in certain cases, liver biopsy. Learn how to assess the reliability of a TE exam, interpret discordant NITs, and when to escalate to cross-sectional imaging or histologic confirmation. This podcast also highlights the evolving role of fat fraction in therapy response, limitations in current FDA indications for resmetirom, and how emerging data may shape future clinical pathways for patients with compensated cirrhosis. Whether you're in primary care, GI, or hepatology, this discussion offers critical insights to improve accuracy in staging liver disease and optimizing treatment strategies for patients with MASH.
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Monitoring for MASLD in Type 2 Diabetes
October 2025
In this educational session, Punam Punja, MMS, PA-C, from Emory Healthcare in Atlanta, discusses the crucial connection between type 2 diabetes and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). With over 15 years of hepatology experience, Punam outlines a practical, evidence-based approach for screening and monitoring patients with type 2 diabetes who are at risk for MASH (Metabolic Associated Steatohepatitis). She explains how the American Diabetes Association (ADA) now recommends routine fibrosis screening using the FIB-4 index, a simple, non-invasive calculation that helps identify patients at risk for advanced fibrosis — the strongest predictor of liver-related outcomes. Punam breaks down risk thresholds, screening intervals, and the role of secondary assessments such as transient elastography or ELF testing. She also emphasizes the importance of patient education, noting that unlike diabetic complications such as retinopathy, MASH is often silent but reversible with lifestyle modification. As October marks National Liver Awareness Month, Punam encourages APPs to make liver screening a standard part of diabetes care.
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NITs: A Practical Overview: Navigating the Basics
November 2025
Join Renee Pozza, a hepatology nurse practitioner with more than 25 years of experience, as she breaks down the essentials of non-invasive testing and fibrosis assessment in patients with metabolic-associated steatotic liver disease (MASLD) and metabolic-associated steatohepatitis (MASH). In this educational session, Renee reviews how to identify patients early, interpret key laboratory scores such as FIB-4 and ELF, and apply imaging tools like FibroScan® and MRE to evaluate liver fat and fibrosis. Learn how to distinguish simple steatosis from progressive fibrosis, recognize markers of advanced liver disease, and integrate non-invasive tests into clinical workflows across primary care, GI, endocrinology, and hepatology settings. Renee also highlights when to consider pharmacologic interventions—including resmetirom and GLP-1 therapies—and when to refer to hepatology for advanced fibrosis or cirrhosis. For more expert-led resources on MASLD, MASH, and liver health, visit the MASLD Community Network to access webinars, clinical insights, and continuing education for advanced practice providers.
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GHAPPcast: Recognizing the Severity of MASH
January 2025
Thank you to Madrigal for sponsoring this episode of GHAPPcast. In this episode of GHAPPcast, nurse practitioners Patrick Horne and April Morris from discuss the complexities of identifying and managing patients with metabolic-associated steatohepatitis (MASH). They explore clinical approaches, including the use of bloodwork, family history, and advanced diagnostic tools such as FibroScan, to recognize patients at risk. Patrick and April emphasize the importance of lifestyle interventions like diet and exercise alongside new medical therapies, while also offering practical tips for clinicians on patient monitoring and treatment management. Tune in for valuable insights into managing MASH in clinical practice.
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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
August 2025
Join Tessa Janovsky, PA-C from Arizona Liver Health, for a practical and guideline-based discussion on screening for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) in primary care. This session outlines which patient populations Advanced Practice Providers (APPs) should routinely screen—such as individuals with type 2 diabetes, medically complicated obesity, metabolic risk factors with fatty liver on imaging, moderate alcohol use (MetALD), or a family history of MASH cirrhosis. Learn how to apply first-line non-invasive screening tools like FIB-4 and the NAFLD Fibrosis Score, understand their limitations, and incorporate them into busy clinic workflows. Tessa shares strategies for communicating positive results to patients, next steps for further evaluation (ELF test, FibroScan, MRI elastography), and criteria for timely referral to gastroenterology or hepatology. With practical tips for integrating MASLD/MASH screening into electronic medical records, building clinical pathways, and standardizing protocols, this episode equips PCPs and specialists to detect high-risk patients earlier, intervene effectively, and ultimately improve liver health outcomes.
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MASH/MASLD in Type 2 Diabetes: Concurrent Medication Management
November 2025
In this in-depth educational discussion from the GHAPP MASLD Community Network, Allysa Saggese, NP, from Weill Cornell Medicine in New York City, explores the critical intersection between type 2 diabetes, metabolic dysfunction–associated steatotic liver disease (MASLD), and metabolic dysfunction–associated steatohepatitis (MASH). Allysa explains why patients with diabetes are at higher risk for developing MASH and advanced fibrosis, detailing how insulin resistance, excess glucose, and fat accumulation drive inflammation and liver damage. She reviews the most common diabetes medication classes—including metformin, GLP-1 receptor agonists, SGLT2 inhibitors, TZDs (pioglitazone), and DPP-4 inhibitors—and discusses their impact on liver fat, inflammation, and fibrosis, highlighting which options offer the most dual benefit for both glycemic and liver health. Viewers will learn how to approach medication selection and sequencing, when to use caution in cirrhosis or decompensated liver disease, and how to tailor treatment to each patient’s metabolic profile. With clear clinical reasoning and practical insights, Allysa provides a concise roadmap for optimizing diabetes management in patients with MASLD and MASH—balancing glycemic control, liver protection, and overall metabolic wellness.
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