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MASLD AI 06:48 AM
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.
Related Podcast
Discordant NITs, the Gray Zone
July 2025
Join Lindsay Pratt, PA-C, from the University of Colorado School of Medicine’s Hepatology and Liver Transplant Department, as she unpacks the challenges of interpreting discordant results between non-invasive liver testing tools such as FIB-4 and FibroScan in patients with MASLD and MASH. With over 15 years of clinical experience, Lindsay walks viewers through how age, transaminase levels, platelet count, and patient factors like BMI and fasting status can impact test accuracy and reliability. She emphasizes when to consider advanced diagnostics like MRI elastography (MRE) or liver biopsy, and how to tailor decisions to the individual patient, especially when results don't align. This practical session is ideal for hepatology and GI providers navigating complex liver disease management, and includes tips for communicating test limitations and next steps with patients. Learn how to make informed decisions using non-invasive tests while maintaining patient-centered care in the management of fatty liver disease.
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Liver Model Overview
July 2025
Join Alison Moe, PA-C with United Digestive, as she walks through a hands-on demonstration using a life-sized liver model to help patients better understand fibrosis and liver disease progression. In this engaging and practical overview, Allison explains how different stages of liver fibrosis—from normal liver to cirrhosis and hepatocellular carcinoma—can be felt and visualized using a segmented anatomical model. She shares how this tool enhances patient education during discussions about non-invasive liver testing, such as FibroScan, CAP scores, FIB-4, ELF testing, and more. Designed to support visual learners and improve comprehension of disease state, this video is a valuable resource for clinicians and patients navigating the complexities of metabolic-associated fatty liver disease (MASLD) and its progression to MASH. Learn how tactile and visual teaching aids can bridge the gap between diagnostics and patient understanding in hepatology care.
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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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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
October 2025
In this educational video, Cheryl Walsh, ACNP-C, from GI Alliance in Arkansas, shares practical guidance on screening for MASH (Metabolic Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) in the primary care setting. Drawing from over 15 years of experience in gastroenterology, Cheryl highlights how nurse practitioners and advanced practice providers can efficiently identify at-risk patients—particularly those with type 2 diabetes, obesity, or cardiometabolic risk factors such as hypertension and elevated triglycerides. She explains how simple, validated tools like the FIB-4 index and ELF score can be incorporated into routine labs to detect early signs of fibrosis and liver disease progression. Cheryl also discusses communicating positive results, setting appropriate follow-up intervals, and empowering patients through lifestyle modifications and diet counseling. By streamlining screening into busy primary care workflows, clinicians can play a vital role in early detection and prevention of advanced liver disease.
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Addressing Health Disparities: Equity Considerations in MASH/MASLD Care
July 2025
In this episode, Patrick Horne, NP at the University of Florida (UF Health), explores the impact of health disparities and socioeconomic inequality on the diagnosis and management of MASH (metabolic-associated steatohepatitis) and MASLD (metabolic dysfunction-associated steatotic liver disease). With a focus on rural and underserved populations, Patrick discusses how limited access to quality healthcare, healthy food, exercise options, and non-invasive testing (NITs) like FibroScan or MRI elastography can delay diagnosis and worsen outcomes. He shares practical, empathetic strategies for individualizing care, such as using accessible tools like FIB-4 or APRI, promoting low-cost physical activity like walking or swimming, and providing culturally sensitive nutrition advice tailored to financial and geographic realities. Patrick emphasizes the provider’s role as a patient advocate and coach, helping patients navigate barriers and create sustainable lifestyle modifications. This episode offers key insights for clinicians working to close gaps in care and promote equity in liver disease management.
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LFTs Demystified: A Practical Guide for APPs
August 2025
Join Maly Tiev, NP at NYU Langone Health, for this essential educational session on demystifying liver function tests (LFTs), brought to you by the GHAPP MASLD Community Network. In this video, Maly explains how to interpret ALT, AST, alkaline phosphatase, GGT, bilirubin, albumin, INR, and platelet counts in the context of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH (Metabolic Steatohepatitis). Learn why elevated liver enzymes are not always present in MASH, how to distinguish between different causes of abnormal LFTs—including alcohol-related liver disease, viral hepatitis, and drug-induced liver injury—and how serial LFT monitoring can indicate treatment response or disease progression. Discover the importance of using non-invasive tools for fibrosis risk stratification, the role of platelets as a key marker, and how a deeper understanding of synthetic function tests can help identify cirrhosis earlier. Whether you're a clinician or a patient looking to understand the lab work behind fatty liver disease, this presentation offers practical insights for interpreting LFTs with confidence.
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Viral Hepatitis and MASH/MASLD: Understanding the Connection
June 2025
In this episode, Patrick Horne, NP from the University of Florida, explores the important connection between viral hepatitis and MASLD/MASH (Metabolic Dysfunction–Associated Steatotic Liver Disease/Steatohepatitis). While patients may present with a presumed diagnosis of MASLD or MASH, Patrick emphasizes the critical need to rule out coexisting liver diseases such as hepatitis B and C. The presence of both metabolic and viral liver diseases can significantly accelerate liver inflammation, fibrosis progression, and ultimately cirrhosis—a concept he explains using the “two-hit” or even “three-hit” theory. Patrick walks through the recommended screening protocols, including one-time HCV testing for all adults over 18 and complete HBV panels to assess for immunity, past exposure, and chronic infection. He stresses that treating viral hepatitis—especially with today's highly effective antivirals—can and should occur alongside lifestyle modification strategies for MASLD/MASH. He also discusses how liver stiffness measurements can be skewed by active inflammation and suggests reassessing fibrosis after treating viral hepatitis. This episode is a must-watch for providers managing patients with liver disease, highlighting the need for a comprehensive, layered diagnostic approach.
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Alcohol and MASLD/MASH: Navigating the Complex Relationship
August 2025
Join Edith Johannes, NP, UCLA Health, for an in-depth discussion on alcohol consumption in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Alcohol-Related Liver Disease (MetALD). Drawing on over 17 years of experience in liver disease and transplant care, Edith explains the clinical importance of accurately screening and quantifying alcohol use to differentiate between MASLD, MetALD, and Alcohol-Related Liver Disease (ALD). Learn the acceptable alcohol thresholds, how alcohol impacts diagnostic accuracy for fibrosis, and why precise history-taking—down to grams per day—is essential for guiding treatment. This session covers practical strategies for effective patient conversations, cultural sensitivity, use of validated screening tools (CAGE, AUDIT, AUDIT-C), and tips for uncovering underreported intake. Discover how alcohol use can confound non-invasive testing like FIB-4 and elastography, influence eligibility for pharmacotherapy, and accelerate disease progression, cardiovascular risk, and mortality. With a focus on early intervention, lifestyle modification, and multidisciplinary support for alcohol cessation, this talk provides actionable insights for improving liver health outcomes in MASLD and MetALD patients.
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LFTs Demystified: A Practical Guide for APPs
November 2025
In this episode of Liver Functions Demystified, Chantil Jeffreys, FNP from Gastro One in Memphis, Tennessee, shares a practical guide for interpreting liver enzyme results and identifying when to evaluate patients for MASLD (metabolic dysfunction–associated steatotic liver disease) and MASH (metabolic dysfunction–associated steatohepatitis). Drawing from 24 years of clinical experience, she explains how to recognize key patterns such as persistent ALT and AST elevations, the significance of ALT being higher than AST in early MASH, and why associated metabolic risk factors—like type 2 diabetes, obesity, hypertension, and hyperlipidemia—make even mild elevations clinically important. Chantil also reviews the role of other markers including GGT, alkaline phosphatase, bilirubin, albumin, and INR in assessing disease severity and progression. She highlights how to differentiate MASH from alcohol-associated liver disease, viral hepatitis, and drug-induced liver injury, and underscores the importance of serial monitoring to track improvement or progression. This video offers a clear, practical framework for clinicians, APPs, and primary care providers to better evaluate and manage patients with liver disease in everyday practice.
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Alcohol and MASLD/MASH: Navigating the Complex Relationship
June 2025
In this powerful and highly educational episode, Scott Springer, PA-C at Erie County Medical Center in Buffalo, NY, explores the complex and often overlooked relationship between alcohol use and metabolic dysfunction–associated steatotic liver disease (MASLD/MASH). Drawing from his dual expertise in hepatology and addiction medicine, Scott outlines the importance of accurately assessing alcohol use when diagnosing MASLD, MASH, MetALD, or ALD—emphasizing that MASLD and MASH are diagnoses of exclusion and heavily influenced by alcohol consumption thresholds. He discusses best practices for screening, including patient-centered, nonjudgmental interviewing, the use of biomarkers like PEth and urine ethyl glucuronide, and how these tools enhance accuracy and accountability in care. Scott reviews national guidelines that recommend alcohol abstinence for patients with chronic liver disease and presents data showing how even small reductions in alcohol use can significantly lower the risk of cirrhosis. He also unpacks the challenges of interpreting liver tests in patients with ongoing alcohol use, the limitations of non-invasive testing like FibroScan and FIB-4, and how alcohol may disqualify patients from emerging pharmacotherapy such as resmetirom. Finally, he highlights the promising potential of GLP-1 medications in managing both liver fibrosis and alcohol use. This episode is essential listening for hepatology providers, addiction specialists, and any clinician involved in the care of patients with coexisting liver disease and substance use disorders.
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