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August 2025
Join Sarah Dawkins, NP, for quick and practical insights in this edition of GHAPP MASLD Community Network’s APP Insights. Sarah answers common questions from primary care providers about managing patients with hepatic steatosis on imaging but normal liver tests. She explains when to calculate a FIB-4 score, how to interpret mild ALT/AST abnormalities, and when referral to hepatology is necessary. Learn how to assess risk in patients with diabetes, obesity, or metabolic syndrome, and how to rule out other causes like viral hepatitis, alcohol use, drug-induced liver injury, and iron overload. Sarah emphasizes the importance of lifestyle counseling for low-risk patients and provides a clear framework for primary care providers to confidently monitor and manage MASLD without unnecessary referrals. A must-watch for anyone navigating the "gray zone" of liver diagnostics in everyday practice.
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Common Questions from Primary Care Providers About MASH
July 2025
In this educational video, Robin Soto, RN, MSN, FNP-BC from UC San Diego Health, answers common questions from primary care providers about the progression and management of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis). She addresses the often-misunderstood reality that fatty liver disease can progress to cirrhosis, even in patients with no history of alcohol use—challenging the stigma that surrounds liver disease. Robin explains how MASH is a progressive condition, and if left unmanaged, can lead to advanced fibrosis and liver failure. She also shares practical dietary advice for patients, highlighting the benefits of the Mediterranean diet—rich in healthy fats, fiber, and low in processed foods and sugars—as recommended by hepatology societies like AASLD. Importantly, she emphasizes that even modest weight loss (3–10%) can significantly improve steatosis, inflammation, and even reverse fibrosis. This video is a valuable resource for clinicians and patients alike, focused on prevention, early intervention, and empowering lifestyle changes.
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Common Questions From Primary Care Providers About MASH
July 2025
In this informative session, Jennifer Geremia, PA-C, a seasoned gastroenterology physician assistant in tertiary care Boston, addresses some of the most common questions primary care providers have about identifying and managing patients with fatty liver disease, MASLD (Metabolic dysfunction-associated steatotic liver disease), and MASH (Metabolic-associated steatohepatitis). Jennifer highlights the importance of using FIB-4 as a first-line non-invasive test (NIT) in high-risk patients with diabetes, obesity, or other metabolic conditions—noting how easily this tool can be integrated into routine labs via the EMR. She underscores that the liver is often overlooked in chronic disease management and makes a strong case for routine fibrosis screening alongside cardiovascular and diabetes evaluations. The talk also dives into actionable next steps after FIB-4 testing, including elastography, ELF testing, and referrals to GI when needed. Jennifer closes by discussing realistic lifestyle intervention goals—especially the importance of 7–10% weight loss for meaningful reductions in steatosis and fibrosis risk. This session is a must-watch for PCPs, APPs, and clinicians managing metabolic comorbidities and seeking practical, evidence-based strategies for early MASH detection and management.
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Misconceptions About Liver Health
July 2025
In this short and informative video, Miu Lai Ng, a nurse practitioner at Tufts Medical Center, debunks two of the most common myths about liver health. First, she sets the record straight on liver cleanses and detox teas—explaining that your liver already detoxifies your body daily and doesn’t need fad diets or trendy supplements. Instead, what your liver needs is support through sustainable habits like reducing alcohol intake, cutting back on processed sugars, and maintaining a healthy weight. She also highlights a critical point: liver disease is often silent, and many people with significant liver damage have no symptoms until it’s advanced. If you're at risk due to metabolic syndrome, alcohol use, or other factors, Miu Lai urges you to talk to your healthcare provider about screening options like FIB-4 or FibroScan®. Your liver works hard for you—this video is a reminder to return the favor with real, lasting care.
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Common Questions From Primary Care Providers About MASH
August 2025
In this MASLD Community Network episode, Edith Johannes, NP at UCLA Health, shares evidence-based guidance on one of the most important questions in managing Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction–Associated Steatohepatitis (MASH): how much weight loss is needed to improve liver health. Drawing on years of experience in hepatology and liver transplant care, Edith explains how weight loss can reduce liver fat (steatosis), decrease inflammation, improve or even reverse fibrosis, and support better overall metabolic health. Research shows that achieving more than 10% weight loss can result in 100% improvement in steatosis, MASH resolution in 90% of patients, and fibrosis regression in over 80%. Even smaller amounts of weight loss—5% to 10%—provide significant liver and metabolic benefits, while exercise and dietary changes can help improve liver function even without weight loss. Edith also discusses when additional treatments like GLP-1s, bariatric surgery, or resmetirom may be needed. This video is essential for healthcare providers, patients, and caregivers seeking practical, science-backed strategies to manage MASLD and MASH effectively.
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Misconceptions About Liver Health
July 2025
In this quick myth-busting session, Elizabeth Alqueza, PA-C from Beth Israel Deaconess Medical Center in Boston, addresses two of the most common misconceptions in hepatology related to steatotic liver disease (MASLD/MASH). First, she explains that liver disease is not always fixed or irreversible—and with proper management and elimination of the underlying cause, liver fibrosis can improve over time, a trend often monitored through FibroScan®. Second, she clarifies that significant liver improvement does not require extreme weight loss. In fact, a modest 5–10% reduction in total body weight—sometimes as little as 10–20 pounds—can lead to measurable improvements in liver inflammation and fibrosis. This video is ideal for providers and patients seeking a clearer understanding of how lifestyle changes can reverse liver disease and why timely, targeted interventions matter.
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Common Questions from Community GI About MASH
July 2025
In this insightful video, Christie Morrison, a local advanced practice provider with the GHAPP MASLD/MASH Community Network, answers two of the most frequently asked questions from community GI providers: when to refer patients with MASH to a transplant center and how to evaluate liver fibrosis when FibroScan® isn’t accessible. Christy emphasizes the importance of using non-invasive testing (NITs)—including FIB-4 and ELF (Enhanced Liver Fibrosis) scores—to help identify patients with F3 fibrosis, who are at higher risk for rapid progression to cirrhosis and hepatocellular carcinoma (HCC). She encourages early referral to transplant hepatology to avoid delays in care, especially given long wait times and the value of multidisciplinary support teams at transplant centers. For clinicians without access to FibroScan, Christy shares practical alternatives such as ordering reflex testing to ELF via major labs and leveraging easy-to-use digital tools like MDCalc for FIB-4 calculation. This episode is a valuable resource for GI providers looking to optimize liver care pathways and prevent late-stage complications in MASLD and MASH patients.
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Misconceptions About Liver Health
July 2025
In this quick but powerful video, Jeremy Davis, NP from Shreveport, Louisiana, addresses some of the most common misconceptions about liver health that he encounters in clinical practice. Many patients believe that liver disease only occurs in people who drink alcohol, but Jeremy explains how conditions like MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis) can affect individuals regardless of alcohol use. He also clears up the myth that only overweight patients are at risk, pointing out that co-morbidities such as hypertension, high cholesterol, cardiovascular disease, and type 2 diabetes can contribute to liver disease—even in patients with a normal BMI. Finally, Jeremy explains why normal liver enzyme labs (ALT and AST) don’t always rule out liver disease, making it crucial to assess underlying risk factors and improve provider and patient awareness. This video is a valuable resource for both healthcare professionals and patients looking to better understand non-alcoholic liver disease and why early screening matters.
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Common Questions from Primary Care Providers About MASH
July 2025
In this FAQ session, Brian Lam, PA-C, breaks down a common question he receives from primary care providers, endocrinologists, and even other GI specialists: Which patients with fatty liver should be referred to hepatology or GI for further evaluation? Using a clear and practical approach, Brian explains how to apply FIB-4, a simple lab-based non-invasive test, to guide referrals. He emphasizes that patients with metabolic syndrome—especially those with diabetes—are at significantly higher risk for MASH (Metabolic dysfunction-associated steatohepatitis), with roughly 1 in 3 diabetic patients affected. If the FIB-4 is greater than 1.3, or greater than 2.0 in adults over 65, it's time to refer. Brian also highlights the utility of FIB-4 with reflex to ELF, now available through major labs like LabCorp and Quest, as an efficient two-step method to detect advanced fibrosis and at-risk MASH. This video is perfect for busy clinicians looking for a referral-friendly workflow to catch MASH early and improve liver health outcomes in high-risk populations.
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Common Questions From Community GI About MASH
July 2025
In this session, Lavinia Iordache, PA-C, from the University of Miami, draws on a decade of experience in inpatient and outpatient hepatology to address common management questions related to MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis). She provides practical guidance for gastroenterology providers navigating when to monitor versus refer patients with fibrosis, how to interpret and time non-invasive testing (NITs) such as FIB-4, and when liver biopsy may still play a role—particularly in cases with persistently elevated liver enzymes despite lifestyle improvement. Lavinia also dives into the referral criteria for hepatology, the evolving role of resmetirom in stage 2–3 fibrosis, and the critical topic of HCC screening. While current AASLD guidelines limit HCC surveillance to cirrhosis, Lavinia highlights emerging evidence and EASL recommendations supporting imaging in patients with F3 fibrosis based on individualized risk factors like diabetes, genetics, and obesity. She also explains why CT or MRI is often preferred over ultrasound in MASLD patients due to obesity-related imaging limitations. This is a must-watch for hepatology and GI teams managing liver fibrosis in metabolic disease.
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Common Questions From Patients About MASH
July 2025
In this practical and patient-focused discussion from the GHAPP MASLD/MASH Community Network, we address some of the most frequently asked questions by patients newly diagnosed with MASLD (Metabolic dysfunction-associated steatotic liver disease). Many patients wonder how they can have liver disease if they don’t drink alcohol. This video explains the evolution from NAFLD to MASLD, emphasizing that MASLD is rooted in metabolic risk factors—not alcohol use—and commonly affects individuals with diabetes, obesity, and hypertension. Viewers will also learn about evidence-based lifestyle interventions, including the benefits of a hypocaloric diet, the recommended Mediterranean-style eating pattern, and 150 minutes of weekly physical activity. Finally, we tackle the question “Is MASLD curable?” with empowering guidance on how weight loss and exercise can help reverse liver damage and reduce liver fat. This is a must-watch for clinicians, care teams, and patients seeking clarity and confidence in managing this increasingly common liver disease.
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