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August 2025
In this MASLD and MASH Community Network, Tessa Janovsky, PA-C at Arizona Liver Health, answers common questions from primary care providers about Metabolic Dysfunction–Associated Steatohepatitis (MASH) and its updated terminology. She explains why MASH has replaced the term NASH, highlighting the shift to reflect underlying metabolic drivers such as obesity and type 2 diabetes while removing stigmatizing language. Tessa discusses how normal or mildly elevated liver enzymes do not rule out MASH, the importance of screening high-risk groups—including patients with diabetes, obesity, metabolic syndrome, or incidental fatty liver on imaging—and why the FIB-4 score is the preferred first-line test for fibrosis risk assessment. She also reviews the first FDA-approved medication for MASH, resmetirom, as well as the role of GLP-1 therapies and upcoming treatment options. Whether you’re a clinician seeking updated screening guidelines or a patient wanting clarity on diagnosis and management, this session provides clear, evidence-based guidance on identifying and treating MASH.
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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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MASLD Basics With Ann Moore
September 2025
In this episode of MASLD Basics, Ann Moore, NP with Arizona Liver Health, explains the new terminology and approach to what was once called fatty liver disease. She breaks down how “NAFLD” is being replaced with steatotic liver disease and how patients are now categorized based on underlying drivers such as metabolic dysfunction, alcohol use, or other conditions. Ann highlights why MASLD and MASH are the most common and important to recognize, what risk factors providers should look for, and why early detection matters. She also discusses how primary care teams can use simple non-invasive tests, lifestyle changes, and new treatment options to identify at-risk patients before fibrosis and cirrhosis develop. This talk is designed to give APPs, clinicians, and healthcare providers a clear, practical overview of the evolving landscape of liver disease care.
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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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MASLD Pharmacotherapy With Kelly Smeester
August 2025
Join Kelly Smeester, MMS, RD, PA-C, from South Denver Gastroenterology for an in-depth pharmacologic review of current and emerging treatment options for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH (Metabolic Dysfunction-Associated Steatohepatitis), as part of the GHAPP MASLD Community Network. This session outlines a comprehensive treatment strategy focused on three key goals: promoting weight loss, reducing cardiovascular risk, and targeting liver-specific interventions. Kelly highlights lifestyle and pharmacologic interventions including GLP-1 receptor agonists, GIP/GLP-1 dual agonists, and bariatric surgery, while exploring evidence-based guidance for treating comorbidities like type 2 diabetes, hypertension, and dyslipidemia. She dives into the latest data on vitamin E, pioglitazone, and the newly FDA-approved Resmetirom (Rezdiffra)—a thyroid hormone receptor beta agonist indicated for adults with non-cirrhotic NASH and F2–F3 fibrosis. Learn about the results from pivotal clinical trials like ESSENCE, PIVENS, and MAESTRO-NASH, the importance of NAFLD activity scoring, as well as dosing strategies, adverse effects, and drug interactions to consider when using Resmetirom. The session also explores practical monitoring approaches including FibroScan, MRI-PDFF, and ELF scores, with an outlook on evolving treatment duration and insurance coverage considerations. Whether you're a hepatology provider or part of a multidisciplinary care team, this presentation offers critical insights to optimize MASH treatment pathways today and in the future.
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Comparing F3 and F4 Fibrosis With Christie Morrison
August 2025
In this expert-led session, Christie Morrison, NP, shares a comprehensive case-based discussion on comparing F3 vs F4 fibrosis in patients with MASH (Metabolic Dysfunction-Associated Steatohepatitis). Through the lens of two real-world clinical scenarios, Christie breaks down the nuanced differences in non-invasive diagnostic tools such as FIB-4, ELF scores, and FibroScan KPA readings, while guiding providers on how to stratify risk, monitor disease progression, and tailor interventions appropriately. Viewers will learn how elevated liver enzymes, declining platelet counts, and steatosis scores influence decision-making in patients with metabolic comorbidities like type 2 diabetes, hypertension, and hyperlipidemia. The session emphasizes evidence-based lifestyle and pharmacologic strategies, including the potential role of resmetirom (Rezdiffra) in F3 fibrosis and why it’s contraindicated in advanced cirrhosis. Learn when to initiate HCC surveillance, how to interpret borderline labs, and the importance of integrating GLP-1s, dietitian referrals, and cardiometabolic care to slow or reverse fibrosis progression. Whether you’re managing intermediate or advanced fibrosis, this educational session provides invaluable insights into optimal MASH care pathways and staging techniques.
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Lifestyle Management With Robin Soto
July 2025
Join Robin Soto, NP from UC San Diego Health, for a practical and case-based discussion on lifestyle management in patients with MASLD and MASH (Metabolic dysfunction-associated steatotic liver disease and steatohepatitis). In this presentation, Robin walks through the diagnosis and management of a representative patient case, highlighting how to assess fibrosis risk using non-invasive tools like FIB-4 and FibroScan, and emphasizing the critical role of lifestyle intervention. Learn how diet, exercise, and behavioral counseling can slow or reverse liver disease progression—especially in patients with cardiometabolic risk factors such as type 2 diabetes, obesity, and hyperlipidemia. Robin also addresses real-world barriers to dietary change, including cultural preferences, food accessibility, and socioeconomic challenges, while offering practical strategies for behavior change and patient engagement. This session is part of the GHAPP MASLD/MASH Community Network and includes educational resources on MASH and promotional information about Rezdiffra, a new treatment option for patients with advanced disease. Whether you're a hepatology provider or managing liver disease in primary care, this presentation offers essential, real-world guidance to support your clinical decision-making.
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Misconceptions About Liver Health With Jill Olmstead
September 2025
Join Jill Olmstead, DNP from Providence Health in Southern California for an eye-opening GHAPP MASLD Community Network Insight on the biggest misconceptions about liver health. In this session, Jill explains why fatty liver disease is not “normal” or harmless, but a serious metabolic disorder linked to obesity, prediabetes, diabetes, and high cholesterol. She highlights how fat in the liver causes cellular injury, leading to fibrosis and even cirrhosis if untreated. Jill also addresses the common myth that alcohol is safe in moderation—reminding patients that alcohol is a liver toxin and no amount is risk-free, despite outdated beliefs about red wine being heart-protective. This educational talk empowers providers and patients alike to recognize fatty liver disease early, manage risk factors, and adopt lifestyle changes that protect long-term liver health. Watch more from the MASLD & MASH Community Network to stay informed on advances in fatty liver disease education and care.
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MASLD vs MetALD With Jennifer Geremia
September 2025
In this GHAPP MASLD Community Network presentation, Jennifer Geremia, PA-C explains how to differentiate metabolic dysfunction–associated steatotic liver disease (MASLD) from metabolic dysfunction plus alcohol-associated liver disease (MetALD) and how to manage patients who sit on the MASLD–MetALD spectrum. Using a classic case (52-year-old with BMI 29.4, PCOS, hypertension, hyperlipidemia, ultrasound-confirmed steatosis, FibroScan 11.4 kPa [F3] and CAP 310), she shows how to combine history, “standard drink” counseling, AUDIT-C screening, and objective biomarkers like PEth to uncover under-reported alcohol use, quantify grams/day or week, and classify risk. You’ll learn practical algorithms for ruling out alternative etiologies, assessing cardiometabolic drivers, interpreting noninvasive tests, and estimating 5-year decompensation risk across MASLD, MetALD, and ALD. The session closes with actionable care steps: lifestyle and Mediterranean-style nutrition, exercise and weight-loss targets, strict alcohol cessation (and referral when appropriate), consideration of pharmacologic options in advanced fibrosis, and when to initiate HCC surveillance. Scan the QR code to confirm attendance and access more MASLD/MetALD education and resources.
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Differentiating Between F3 and F4
July 2025
In this comprehensive discussion, HoChong Gilles, a nurse practitioner with 25 years of hepatology experience at the Richmond VA Medical Center, explores the critical importance of accurately distinguishing between F3 (advanced fibrosis) and F4 (cirrhosis) in patients with MASH (metabolic-associated steatohepatitis). While both stages carry increased risks of liver-specific and overall mortality, Gilles explains that F3 may still be reversible with lifestyle changes or pharmacotherapy, whereas F4 signals irreversible liver damage with heightened risk of complications like portal hypertension, hepatic encephalopathy, and liver cancer. Viewers will gain a deeper understanding of how non-invasive tests—like FIB-4, ELF, FibroScan, and MRE—perform in identifying fibrosis stage, including their limitations and overlaps. Gilles also outlines when to consider liver biopsy, especially in cases with discordant test results, atypical features, or clinical uncertainty. This video emphasizes how staging accuracy informs eligibility for therapies, surveillance strategies like HCC screening, and overall prognosis. Learn how to approach this nuanced distinction in clinical practice and why F3 vs. F4 isn't just semantics—it's a turning point in patient care.
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MASLD Pharmacotherapy With Whitney Steinmetz
August 2025
Join Whitney Steinmetz, NP, from Presbyterian Medical Group in Albuquerque, NM, for an in-depth review of pharmacotherapy in MASLD and MASH, presented as part of the GHAPP MASLD Community Network. In this comprehensive CME-eligible session, Whitney explores the multimodal treatment approach for patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH), focusing on three therapeutic pillars: obesity management, cardiometabolic risk reduction, and liver-directed therapies. The discussion covers mechanisms, clinical trial data, and practical considerations for key treatment options, including GLP-1 receptor agonists, vitamin E, pioglitazone, and resmetirom (Rezdiffra). Whitney highlights findings from landmark studies such as ESSENCE, PIVENS, and MAESTRO-NASH, and explains how thyroid hormone receptor beta activation through resmetirom reduces hepatic fat, inflammation, and fibrosis in F2-F3 patients. She also offers guidance on non-invasive monitoring (FibroScan, MRE, ALT), drug–drug interactions, and how evolving guidelines from AASLD and ESLD shape clinical decision-making. Whether you're treating early-stage fatty liver disease or managing moderate fibrosis in primary care or hepatology, this video provides evidence-based insights to optimize long-term outcomes through targeted pharmacologic strategies and patient-centered care.
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