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MASLD AI 06:37 AM
August 2025
Join Melissa Franco, PA at the University of Miami, for an in-depth episode of the GHAPP MASLD Community Network podcast focused on discordant non-invasive tests (NITs) and navigating the "gray zone" of liver fibrosis staging. Melissa walks through common real-world scenarios where FIB-4, FibroScan, ultrasound, ELF score, and MR elastography deliver conflicting results—exploring why this happens and how to approach it clinically. Learn how patient factors such as obesity, alcohol use, co-morbidities, medications, and test limitations can impact NIT interpretation. Discover Melissa’s expert strategies for re-evaluating results, when to consider liver biopsy, and how to communicate these complexities with patients. From understanding how false elevations occur to using imaging and labs to confirm or exclude advanced fibrosis, this episode provides a practical and evidence-based approach to staging MASLD and MASH when results don’t align. Whether you're managing metabolic liver disease in hepatology or primary care, this is essential listening for interpreting liver diagnostics in nuanced clinical settings.
Related Podcast
Comparing F3 and F4 Fibrosis With Lindsay Pratt
July 2025
Join Lindsey Pratt, PA-C from the University of Colorado Liver Transplant Program, for an in-depth clinical comparison of F3 and F4 fibrosis in patients with MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). Using an identical patient profile with differing non-invasive testing results, Lindsey demonstrates how to accurately stage fibrosis using tools like FIB-4, FibroScan, CAP score, and ELF test—emphasizing when pharmacologic intervention is appropriate and when advanced monitoring becomes critical. This session explores the clinical implications of fibrosis staging, treatment pathways including resmetirom (Rezdiffra), the role of GLP-1 receptor agonists, and practical nutrition and lifestyle strategies. For F4 patients, Lindsey outlines key elements of surveillance for hepatocellular carcinoma (HCC), portal hypertension management, and transplant evaluation. Whether you're in hepatology or primary care, this case-based discussion offers evidence-backed guidance for managing patients across the MASLD/MASH spectrum and preventing liver disease progression.
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MASLD Pharmacotherapy With Anthony Derencius
August 2025
Join Anthony Derencius, PA-C, sub-investigator at Pinnacle Clinical Research, for an in-depth, case-based discussion on the pharmacologic management of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH (Metabolic Steatohepatitis) in this GHAPP MASLD Community Network presentation. With clinical insights from both hepatology practice and research, Anthony explores the multifactorial approach to managing metabolic liver disease—emphasizing weight loss strategies, GLP-1 receptor agonists, cardiovascular risk reduction, and liver-directed therapies. Learn how medications like semaglutide and tirzepatide play a role in weight loss and glycemic control, and how vitamin E and pioglitazone are still considered under specific circumstances. A major highlight includes the mechanism and clinical data behind resmetirom, the first FDA-approved therapy for MASH with F2–F3 fibrosis. Anthony explains its thyroid hormone receptor β-selectivity, efficacy data from the MAESTRO-NASH trial, real-world safety considerations, drug interactions, and monitoring protocols. This presentation is essential viewing for clinicians managing MASLD and MASH in both community and research settings, offering practical strategies, current guidelines, and a look into the future of liver-specific pharmacotherapy.
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Serological Workup: A Step-by-Step Guide With Jill Olmstead
September 2025
Join Jill Olmstead, DNP from Providence Health in Southern California for a step-by-step guide on working up patients with elevated liver enzymes in this MASLD & MASH Community Network podcast. Jill reviews how to distinguish acute vs. chronic liver injury, interpret patterns of hepatocellular vs. cholestatic damage, and order the right serologic tests, including viral hepatitis panels, autoimmune markers (ANA, ASMA, AMA), Wilson’s disease, alpha-1 antitrypsin deficiency, iron studies, and celiac screening. She highlights common causes such as alcohol use and MASLD—now one of the leading causes of liver transplantation—and explains when to use abdominal ultrasound, MRCP, or ERCP to assess for gallstones, biliary obstruction, or sludge. Jill also emphasizes the role of noninvasive fibrosis assessment (FIB-4 score, FibroScan®, fibrosis panels) in staging and treatment planning. With practical insights on history taking, medication review, alcohol counseling, and referral thresholds, this episode provides APPs, GI providers, and hepatology clinicians with a clear framework to evaluate and manage patients with abnormal liver tests and protect long-term liver health.
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MASLD Pharmacotherapy With Summer Collier
August 2025
Join Summer Collier, FNP, from UC San Diego Health, for a comprehensive discussion on pharmacotherapy for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH, presented through the GHAPP MASLD/MASH Community Network and sponsored by Madrigal Pharmaceuticals. In this session, Summer outlines the foundational role of lifestyle modification in treating MASLD, including diet, exercise, and weight loss, while emphasizing the growing need for liver-directed therapies in patients with moderate to advanced fibrosis. She reviews the clinical use of GLP-1 receptor agonists such as semaglutide and tirzepatide, which aid in glycemic control and significant weight loss, and explores their application in hepatology—including key data showing MASH resolution and fibrosis improvement. The discussion also addresses older treatment options like vitamin E and pioglitazone, explaining their risks, limitations, and patient selection criteria. The highlight of the presentation is a detailed analysis of resmetirom (Rezdiffra)—the first FDA-approved therapy for non-cirrhotic NASH with F2–F3 fibrosis. Summer walks through the MAESTRO-NASH trial, covering the mechanism of THR-β activation, improvements in liver histology, safety data, and practical prescribing guidance, including non-invasive monitoring, statin dose considerations, and drug–drug interactions. The session concludes with expert insights on staging, treatment duration, insurance access, and the evolving future of MASLD therapy. A must-watch for hepatology, GI, and primary care providers seeking to implement the latest evidence-based approaches in managing fatty liver disease.
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MASLD vs MetALD With Chantil Jeffreys
September 2025
Chantil Jeffreys, NP at Gastro One, offers a clear, case-based overview of metabolic dysfunction–associated steatotic liver disease (MASLD), MASH, and mixed-etiology MET-ALD. Using a common clinic scenario, she explains how to recognize steatotic liver disease, why accurate alcohol history matters, and how non-invasive tools (e.g., FibroScan for stiffness and CAP, alcohol biomarkers like PEth/EtG) can clarify what’s driving liver injury. You’ll get practical guidance on lifestyle therapy—Mediterranean-style nutrition, sustainable weight loss, and regular aerobic plus resistance exercise—along with when to consider medications, specialist referral, and HCC surveillance. Ideal for APPs and GI clinicians seeking a simple, patient-centered approach to preventing progression from fatty liver to advanced fibrosis and cirrhosis.
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LFTs Demystified: A Practical Guide for APPs
July 2025
In this informative session, Anthony Derencius, PA-C and sub-investigator at Pinnacle Clinical Research, provides a practical and accessible breakdown of liver function tests (LFTs) and liver-associated enzymes, with a focus on their role in diagnosing and monitoring fatty liver disease—including MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (metabolic-associated steatohepatitis). Drawing from years of experience in both general and transplant hepatology, Anthony explains how to interpret key markers like ALT, AST, alkaline phosphatase, bilirubin, albumin, and GGT. He emphasizes why elevated or even normal LFTs don’t always tell the whole story, and how a full workup—including viral hepatitis panels, autoimmune markers, alcohol-related labs, imaging, and non-invasive fibrosis assessments—can help uncover the root cause of liver injury. This video also walks viewers through when to consider additional tools like FIB-4, ELF score, FibroScan, or even liver biopsy. Whether you're a primary care provider or hepatology specialist, this session will sharpen your ability to distinguish between benign lab variations and signs of serious liver disease, ultimately supporting earlier diagnosis and better outcomes for your patients.
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Non-Invasive Testing With Janet Gripshover
July 2025
In this in-depth and practical discussion, Janet Gripshover, NP from Cedars-Sinai in Los Angeles, explores the evolving role of non-invasive testing (NITs) in the diagnosis and risk stratification of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). Drawing from real-world experience and a case study involving a 65-year-old patient with multiple cardiometabolic risk factors, she breaks down the latest 2025 approaches to fibrosis assessment—highlighting the use of FIB-4, ELF score, vibration-controlled transient elastography (FibroScan®), and MR elastography. Gryover also emphasizes how combining tests across modalities can improve accuracy and patient care while avoiding the risks of liver biopsy. Learn how liver stiffness, lab values, and clinical history all intersect to guide care and treatment decisions in patients with fatty liver disease. This session is part of the MASLD/MASH Community Network and is ideal for providers, specialists, and anyone interested in the forefront of liver disease management.
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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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Motivational Interviewing: Practical Techniques for Lifestyle Adherence
August 2025
Discover how motivational interviewing can transform the management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) by empowering patients to make sustainable lifestyle changes. In this session, we explore why lifestyle modification—particularly achieving 5–10% weight loss—is the most effective intervention for MASLD, yet often fails when approached through traditional “diet and exercise” advice alone. Learn the four core principles of motivational interviewing—expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy—and how to apply them in real-world clinical encounters to improve patient engagement and outcomes. Through practical strategies, sample dialogue, and a compelling patient case study, this discussion highlights how small, achievable changes in diet and physical activity can reduce hepatic inflammation, improve insulin resistance, and even reverse fibrosis. Whether you’re a hepatology provider, primary care clinician, or allied health professional, you’ll gain actionable tools to activate patient motivation, overcome barriers, and support lasting behavioral change in MASLD care.
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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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