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MASLD AI 08:34 PM
September 2025
Pharmacotherapy for MASLD is rapidly evolving, and clinicians now have more tools than ever to guide treatment decisions. In this session, Milly Ng, NP at Tufts Medical Center in Boston, breaks down a practical framework for when to initiate treatment, how to select the right therapy, and what monitoring strategies to use. From lifestyle modification and statins to GLP-1 receptor agonists and the first FDA-approved liver-directed therapy, resmetirom, this discussion highlights both established and emerging options. You’ll also learn how GLP-1s can support weight loss and liver health, the evidence behind vitamin E and pioglitazone, and the pivotal Maestro NASH trial that secured accelerated approval for resmetirom. Whether you’re managing patients with obesity, diabetes, or advanced fibrosis, this overview offers actionable strategies to simplify complex decisions and improve outcomes in MASLD/MASH care.
Related Podcast
MASLD Pharmacotherapy With Tessa Janovsky
September 2025
Join Tessa Janovsky, PA-C from Arizona Liver for a practical update on MASLD pharmacotherapy—from whole-patient metabolic management to liver-directed treatment. This session reviews why care must target the entire metabolic syndrome (weight, type 2 diabetes, hypertension, dyslipidemia, cardiovascular risk), the impact of 7–10% weight loss (and why many patients need adjuncts), and how to choose between diet/physical activity, anti-obesity medications, and bariatric surgery for select cases. You’ll learn where GLP-1 receptor agonists fit (mechanism, expected weight and glycemic effects, GI side effects, peri-procedure anesthesia considerations, and use in compensated disease), when to use statins safely in fatty liver, and how to stage and monitor with FIB-4, FibroScan/elastography, and other non-invasive tests. Tessa also summarizes legacy data for vitamin E and pioglitazone (benefits and limitations) and highlights the first FDA-approved therapy for non-cirrhotic MASH with F2–F3 fibrosis, resmetirom—including mechanism (THR-β agonism), tolerability, drug–drug interaction checkpoints, and practical follow-up (restaging and lifestyle coaching). If you’re a GI/hepatology clinician or APP aiming to streamline risk reduction, staging, and evidence-based therapy for MASLD/MASH, this concise talk delivers clinic-ready guidance.
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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 Basics With Jessica Crimaldi
August 2025
Join Jessica Crimaldi, NP, from the Cleveland Clinic, for an in-depth and practical overview of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease), presented through the GHAPP MASLD Community Network and supported by Madrigal Pharmaceuticals. In this foundational session, Jessica breaks down the new 2023 steatotic liver disease nomenclature, replacing NAFLD and NASH with MASLD and MASH, and explains how these changes align with updated AASLD guidelines. Through a case-based approach, she walks through key diagnostic criteria, highlighting the role of cardiometabolic risk factors, non-invasive assessments such as FIB-4, FibroScan, and ELF, and when to consider liver biopsy for staging fibrosis. Learn how to stratify patients based on metabolic profiles, evaluate imaging and lab results, and identify those at risk for progression to advanced fibrosis or cirrhosis. Jessica also discusses global epidemiology, genetics (like PNPLA3), environmental contributors, and the clinical importance of early detection. With a comprehensive workup strategy for primary care and GI settings, this session equips providers to implement guideline-driven MASLD evaluation and referral practices for improved patient outcomes.
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Beyond Basic NITs: When is Liver Biopsy or Advanced Imaging
July 2025
In this episode, Brian Lam, PA, Associate Director of Research at Inova’s Liver and Obesity Research Program in Northern Virginia, explores the nuanced decision-making involved in going beyond basic non-invasive tests (NITs) for diagnosing and managing MASH (metabolic dysfunction-associated steatohepatitis). While FIB-4 and transient elastography are useful initial tools, Brian breaks down when and why clinicians should consider more advanced diagnostics—such as MR elastography (MRE), proton density fat fraction (PDFF), and in certain cases, liver biopsy. Learn how to assess the reliability of a TE exam, interpret discordant NITs, and when to escalate to cross-sectional imaging or histologic confirmation. This podcast also highlights the evolving role of fat fraction in therapy response, limitations in current FDA indications for resmetirom, and how emerging data may shape future clinical pathways for patients with compensated cirrhosis. Whether you're in primary care, GI, or hepatology, this discussion offers critical insights to improve accuracy in staging liver disease and optimizing treatment strategies for patients with MASH.
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Non-Invasive Testing With Erin Tanner
July 2025
In this educational session from the GHAPP MASLD & MASH Community Network, Erin Tanner, PA-C from Gastro Health in Birmingham, Alabama, presents a practical overview of non-invasive testing (NIT) options for evaluating and managing MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). Using a patient case study, Erin explores how clinicians can effectively utilize tools like FIB-4, FibroScan® (VCTE and CAP), ELF, MRE, and other emerging imaging and serum biomarkers to assess hepatic steatosis and fibrosis without the need for liver biopsy. The talk breaks down the pros, cons, and clinical accuracy of various NITs—including shear wave elastography, MRI-PDFF, and proprietary serum markers—and offers guidance on how to apply these tools in real-world hepatology and primary care settings. Special attention is given to identifying patients with metabolic risk factors, interpreting indeterminate FIB-4 scores, and knowing when to refer patients for further hepatology evaluation. Whether you’re new to liver disease management or looking to update your MASLD/MASH care pathways, this session offers clarity on how to stratify fibrosis risk and make informed clinical decisions using non-invasive diagnostics.
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APP Insight: Misconceptions About Liver Health
June 2025
In this video, Kelly Smeester, PA-C from South Denver Gastroenterology, addresses some of the most common and harmful misconceptions about liver health. One major myth she tackles is the belief that liver disease only affects those who drink excessive amounts of alcohol. Kelly explains that liver disease has many causes—including autoimmune conditions, viral infections, and metabolic dysfunction—meaning even individuals who don’t drink at all may still be at risk. She emphasizes the dangers of relying on unregulated “liver detox” supplements, clarifying that the liver is a natural detox organ and doesn’t require external cleanses, which may actually do more harm than good. Kelly also highlights how liver disease can be entirely asymptomatic, particularly in patients with conditions like type 2 diabetes, obesity, hypertension, and high cholesterol. Finally, she reinforces that cirrhosis is not solely alcohol-related and can result from steatotic liver disease, making regular liver evaluations and screenings crucial for early detection and management. This video is an essential resource for patients and providers aiming to better understand liver health beyond outdated myths.
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MASLD Pharmacotherapy With HoChong Gilles
September 2025
In this MASLD Community Network webcast, HoChong Gilles, DNP from the Central Virginia VA Health Care System, provides an in-depth review of pharmacotherapy for MASLD and MASH. The session highlights how management historically focused on lifestyle modification, weight loss, and cardiometabolic risk reduction, and how the treatment landscape shifted in March 2024 with the FDA approval of resmetirom (Rezdiffra)—the first therapy specifically indicated for non-cirrhotic MASH with stage 2–3 fibrosis. HoChong also reviews the evidence and practical use of GLP-1 receptor agonists like semaglutide, including data from the ESSENCE trial, as well as the limited but notable roles of vitamin E and pioglitazone. Key discussion points include drug mechanisms, clinical trial outcomes, real-world safety considerations, drug–drug interactions, and monitoring strategies for patients on therapy. This presentation underscores the importance of integrating lifestyle change with emerging pharmacologic options to improve liver outcomes in patients with MASLD and MASH.
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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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Comparing F3 and F4 Fibrosis With Maly Tiev
September 2025
Maly Tiev, NP, reviews two real-world cases to explain the critical differences between F3 advanced fibrosis and F4 cirrhosis in patients with MASLD/MASH, and how accurate staging changes treatment, prognosis, and surveillance strategies. Using non-invasive tests (NITs) such as FIB-4, FibroScan/Liver Stiffness (kPa), CAP, and the ELF test, she demonstrates how concordant results can guide management without biopsy, when discordant results may require further imaging or histology, and why platelet count and bilirubin trends are key for identifying cirrhosis. For patients with F3, Maly highlights the importance of lifestyle modification with 7–10% weight loss, diet and exercise counseling, optimization of type 2 diabetes and lipid control, potential use of GLP-1 therapy, and when resmetirom (FDA-approved for MASH with F2–F3 fibrosis) may be considered, along with repeat NITs for monitoring. For patients with F4, management shifts to cirrhosis care, including twice-yearly HCC surveillance (ultrasound ± AFP), variceal screening guided by liver stiffness and platelet thresholds, and strict emphasis on alcohol avoidance and cardiometabolic risk reduction, noting that resmetirom is not used in cirrhotic patients. This case-based discussion provides clinicians, APPs, and hepatology teams with practical tools to approach staging, risk stratification, and surveillance in MASLD/MASH.
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MASLD vs MetALD With Elizabeth Goacher
September 2025
Elizabeth Goacher, PA-C, explains MASLD vs MetALD within the broader Steatotic Liver Disease (SLD) spectrum—and why separating metabolic dysfunction alone (MASLD) from metabolic dysfunction + alcohol exposure (MetALD) changes risk stratification and management. Through a real case, Elizabeth shows how to assess fibrosis risk, interpret CAP/Liver Stiffness, and recognize factors that can inflate stiffness. She reviews practical alcohol quantification, the limits of self-report, and when an objective biomarker like PEth can clarify true exposure—especially for patients with borderline metabolic criteria (e.g., isolated hypertension or hypertriglyceridemia). You’ll learn a stepwise approach for: confirming SLD etiology (exclude DILI, viral hepatitis, monogenic disease), choosing FIB-4, VCTE/FibroScan, or ELF for secondary assessment, deciding when to refer or biopsy for discordant results, and prioritizing therapy (alcohol reduction/cessation, cardiometabolic risk control, lifestyle intervention, and when targeted MASLD pharmacotherapy may be appropriate). She also discusses progression risk (MetALD accelerates vs MASLD), and thoughtful use of HCC surveillance in higher-risk patients. Perfect for APPs, GI/hepatology clinicians, and primary care optimizing real-world MASLD/MetALD care.
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