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September 2025
In this session from the MASLD/MASH Community Network, Allysa Saggese, NP from Weill Cornell Medicine in New York, explores the critical differences between F3 and F4 fibrosis through two detailed case studies. Accurate staging is essential in fatty liver disease management, as it directly impacts treatment decisions, eligibility for FDA-approved therapies like resmetirom, and the need for hepatocellular carcinoma (HCC) surveillance. Allysa explains how non-invasive tests such as FIB-4, FibroScan, ELF, CAP, and MRI elastography compare, when to consider a liver biopsy, and how to interpret discordant results. She also discusses treatment pathways, the role of GLP-1 receptor agonists, lifestyle modification, and monitoring strategies for patients with advanced fibrosis versus cirrhosis. This practical overview provides clinicians with a clear framework to distinguish between F3 and F4, ensuring patients receive timely interventions, surveillance, and education to improve long-term outcomes in MASLD/MASH.
Related Podcast
Lifestyle Management With Jennifer Geremia
August 2025
In this GHAPP MASLD Community Network presentation, Jennifer Geremia, PA-C, from Brigham and Women’s Hospital in Boston, discusses the critical role of lifestyle modifications in managing MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). Using a case-based approach, she highlights how patients with obesity, type 2 diabetes, hypertension, and hyperlipidemia can benefit from evidence-based interventions including dietary changes, weight reduction, and physical activity. The session emphasizes the importance of achieving and maintaining 7–10% weight loss, the benefits of a Mediterranean diet, and combining aerobic and resistance exercise to improve liver health and reduce progression to advanced fibrosis or cirrhosis. Jennifer also explores the challenges of long-term adherence, the impact of genetic and metabolic risk factors, and strategies for engaging patients in realistic and sustainable lifestyle changes. This program underscores how early intervention and multidisciplinary care can prevent liver disease progression and improve outcomes for at-risk patients.
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LFTs Demystified: A practical guide for APPs
July 2025
In this GHAPP MASLD Community Network podcast, Jessica Crimaldi, NP, from the Cleveland Clinic, provides practical, real-world insights into interpreting liver function tests (LFTs) in the context of MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (steatohepatitis). Drawing on over a decade of experience in GI and hepatology, Jessica explains common ALT and AST elevation patterns that should prompt a diagnostic workup, even in asymptomatic patients. She reviews the hepatocellular vs. cholestatic patterns of injury, the value of the R-factor calculator in identifying the likely etiology of liver enzyme abnormalities, and how to differentiate MASH from other liver diseases such as PBC, viral hepatitis, or bile duct obstruction. The episode also addresses key non-liver labs like triglycerides, A1C, and cholesterol, and how they contribute to assessing metabolic risk. Finally, Jessica discusses the role of serial LFT monitoring in evaluating treatment response—highlighting what it means when liver enzyme levels fall and why "normal" LFTs don’t always indicate disease resolution. Whether you're a primary care provider or hepatology specialist, this podcast offers valuable guidance for early detection, risk stratification, and longitudinal monitoring of patients with MASH.
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Non-Invasive Testing With Jeremy Davis
September 2025
Join Jeremy Davis, NP, for a clear, clinic-ready walkthrough of non-invasive testing for MASLD/MASH. Using a real case, Jeremy shows how to risk-stratify patients starting with FIB-4 and when intermediate scores should trigger liver stiffness measurement. Learn practical cutoffs, image-quality checkpoints (valid measures, IQR/median), and common confounders (ALT/AST flares, cholestasis, recent meals, alcohol, obesity, ascites) that can overestimate stiffness. He contrasts pros/cons of VCTE vs. MRE, explains how to pair ELF with FibroScan, and maps decisions to AGA/AASLD-aligned pathways—who to refer, who to monitor, and how often to re-stage. The session closes with actionable counseling on lifestyle, weight loss targets, and cardiometabolic risk control to slow fibrosis progression while minimizing unnecessary biopsies.
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Comparing F3 and F4 Fibrosis With Erin Parkinson
July 2025
In this in-depth clinical discussion, Erin Parkinson, NP from the Tampa General Medical Group Transplant Institute, walks through the nuanced process of differentiating stage 3 and stage 4 fibrosis in patients with MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). Using two illustrative case studies, she explores key clinical signs, lab values, and non-invasive staging tools such as FibroScan, FIB-4, ELF score, and MR elastography. Parkinson discusses the importance of early identification of advanced fibrosis, the reversibility of stage 3 disease, and the implications of a diagnosis of cirrhosis. Erin outlines evidence-based treatment pathways including lifestyle interventions, use of GLP-1 receptor agonists, and initiation of resmetirom (Rezdiffra) for stage 2–3 fibrosis. For cirrhotic patients, the focus shifts to HCC surveillance, screening for clinically significant portal hypertension, and consideration of non-selective beta blockers like carvedilol. This video offers practical insights for hepatology providers navigating the evolving MASLD landscape and highlights how early intervention and accurate staging can impact long-term outcomes.
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APP Insight: Misconceptions About Liver Health
June 2025
In this video, Anthony Derencius, PA-C at Pinnacle Clinical Research, clears up some of the most common misconceptions about liver health—offering valuable insights for both patients and healthcare providers. With extensive experience in hepatology, Anthony emphasizes that liver disease is often silent and asymptomatic, meaning many individuals may feel completely fine while living with a significant liver issue. He cautions against relying on a single lab result or imaging test to determine liver status, especially when assessing for conditions like cirrhosis, and stresses the importance of confirming findings through multiple diagnostic tools over time. Anthony also highlights the need for proactive screening, particularly in patients with risk factors such as obesity, diabetes, or a family history of liver disease. Early detection is key, and he encourages patients to advocate for their liver health by seeking evaluation—even if their provider hasn’t suggested it. This is a must-watch for anyone aiming to better understand the complexities of liver disease and the importance of early and accurate diagnosis.
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APP Insight: Common Questions from Community GI About MASH
June 2025
In this informative video, Janet Gripshover, DNP, FNP-BC, and nurse manager for the liver transplant program at Cedars-Sinai, answers key questions about managing MASH (Metabolic Dysfunction–Associated Steatohepatitis) and navigating non-invasive testing. She addresses a common clinical challenge—what to do when FIB-4 and FibroScan results are discordant. Janet explains that while non-invasive tests are useful, they're not foolproof, and when results are unclear—especially in patients with significant metabolic risk factors—liver biopsy remains the gold standard for accurate diagnosis. She also shares expert recommendations on dietary changes for patients with fatty liver disease, emphasizing alcohol avoidance, high-protein, low-fat, and lower-carb diets, as well as achievable weight loss goals (around 5% of body weight). Janet highlights when to escalate care beyond lifestyle interventions—typically after 3 to 6 months if there’s no improvement—and discusses options such as pharmacologic therapy or bariatric surgery. This video provides practical, evidence-based guidance for healthcare providers managing the complexities of MASLD and MASH.
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MASLD Basics With Suzanne Robertazzi
July 2025
Join Suzanne, a nurse practitioner from the Washington DC VA Medical Center, as she kicks off a comprehensive lecture series on steatotic liver disease, focusing on the evolving understanding of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). In this foundational session, Suzanne walks through the new nomenclature replacing NAFLD and NASH, and outlines the clinical criteria used to identify and stratify patients along the MASLD–MASH spectrum. Learn how metabolic risk factors such as obesity, prediabetes, hypertension, and dyslipidemia contribute to disease progression, and explore the use of non-invasive diagnostic tools like Fib-4, FibroScan, and ELF scores to assess fibrosis. The session also discusses indications for liver biopsy, the implications of overlapping etiologies (like alcohol-associated liver disease), and strategies for identifying patients at high risk for cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality. This lecture equips clinicians, particularly those in primary care and hepatology, with a practical framework to evaluate steatosis, interpret metabolic profiles, and determine when to refer patients for specialty care. Whether you're new to liver disease or looking for updates on MASLD and MASH terminology, this session is an essential starting point.
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MASLD vs MetALD With Summer Collier
September 2025
In this educational session from the GHAPP MASLD Community Network, Summer Collier, NP at UC San Diego Health, explores the overlap between metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction plus alcohol-associated liver disease (MetALD) through a detailed clinical case study. Using real-world patient data, she highlights key considerations for evaluating, diagnosing, and managing steatotic liver disease, with special focus on teasing out the dual drivers of metabolic risk factors and alcohol consumption. Viewers will learn about diagnostic tools such as FibroScan, CAP scores, and PEth testing, and how these objective biomarkers help distinguish true MASLD from alcohol-driven disease. The discussion also covers pathophysiology, risk of fibrosis progression, patient counseling on lifestyle and alcohol cessation, current treatment recommendations, and hepatocellular carcinoma (HCC) screening in advanced fibrosis. Whether you are a hepatology provider, APP, or clinician interested in MASLD and MetALD, this session provides practical insights into patient education, disease classification, and the importance of standardized definitions for clinical care and research.
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Common Questions from Patients About MASH
July 2025
In this impactful episode, Sherona Bau, NP from UCLA, addresses the most frequent and pressing questions patients ask after being diagnosed with MASLD (Metabolic dysfunction-associated steatotic liver disease) or MASH (Metabolic-associated steatohepatitis)—including concerns about life expectancy, risk of liver failure, liver cancer, and genetic impact on family members. She emphasizes the importance of risk stratification using non-invasive testing, particularly FibroScan®, to determine the extent of fat accumulation and liver fibrosis. Sherona explains that early identification of stage 2 or 3 fibrosis is critical, as treatment options are now available for these stages, offering hope for patients. She also stresses that MASLD is not just a liver disease—it's a systemic, metabolic condition—and encourages coordinated care with endocrinologists, cardiologists, and dietitians. Additionally, she discusses the hereditary nature of fatty liver and the importance of family screening, especially for children of affected individuals. This video offers clear, compassionate guidance for patients and providers navigating the complexities of fatty liver disease.
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MASLD Pharmacotherapy With Chantil Jeffreys
September 2025
In this MASLD Community Network webcast, Chantil Jeffreys, NP, walks through a practical framework for pharmacotherapy in MASLD/MASH—from lifestyle-first approaches to the evolving role of GLP-1 receptor agonists and bariatric/endoscopic options. She clarifies common misconceptions (e.g., statins are safe—and beneficial—for patients with fatty liver), reviews evidence and real-world considerations for vitamin E and pioglitazone, and explains where resmetirom (Rezdiffra) fits today for non-cirrhotic MASH with F2–F3 fibrosis—including monitoring, drug–drug interactions, and documentation tips that support payer approval. The session also covers cardiovascular risk reduction, peri-procedure guidance for GLP-1s, and practical strategies for staging and follow-up so clinicians can confidently personalize therapy and improve outcomes.
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