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MASLD AI 01:12 PM
July 2025
In this episode, Christie Morrison breaks down the fundamentals of non-invasive testing (NITs) for evaluating patients with fatty liver disease, including MASLD and MASH. She explains the key differences between steatosis (MASLD) and steatohepatitis (MASH), highlighting how non-invasive tests can replace liver biopsy for staging fibrosis. Christy reviews common tools like FIB-4, NAFLD fibrosis score, Enhanced Liver Fibrosis (ELF) score, transient elastography (FibroScan), and MR elastography, and outlines how to choose the right test based on patient factors such as co-morbidities, geography, access to labs, and imaging availability. The episode also emphasizes the importance of fibrosis risk stratification, interpreting FIB-4 cutoffs, and monitoring liver stiffness or ELF scores after initiating lifestyle or pharmacologic treatment—including newer therapies like resmetirom. This is a must-watch for APPs, GI clinicians, and primary care providers seeking to improve care pathways and outcomes in patients with metabolic liver disease through practical, accessible strategies for fibrosis detection and management.
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Monitoring for MASLD in Type 2 Diabetes
July 2025
In this episode, Kelly Smeester, PA-C from South Denver Gastroenterology, explores the critical intersection of type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD). Drawing from her background in both hepatology and endocrinology, Kelly offers practical, evidence-based strategies for non-invasive monitoring of liver fibrosis in patients with diabetes who may initially appear low risk. She highlights the utility of tools like FIB-4, ELF score, FibroScan, and MR elastography, while emphasizing the limitations of relying solely on liver function tests (LFTs). Kelly recommends annual FIB-4 screening—easily calculated with existing lab values—and discusses when to escalate to more advanced diagnostics. She also shares how advanced practice providers (APPs) can seamlessly integrate MASH education, lifestyle counseling, and routine screening into the diabetes care workflow, supporting early intervention and long-term liver health. This episode is a must-listen for clinicians looking to optimize care for patients at risk of silent liver disease progression in the setting of metabolic co-morbidities.
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HCC Surveillance: Implementation in Patients with Advanced Fibrosis/Cirrhosis from MASH
July 2025
In this expert-led session, Elizabeth Alqueza, PA-C, from Beth Israel Deaconess Medical Center in Boston, discusses the critical importance of hepatocellular carcinoma (HCC) surveillance in patients with steatotic liver disease, including MASLD and MASH. HCC is a leading cause of cancer-related death worldwide, and early detection is vital for improving survival outcomes. Using a real-world case study, Elizabeth highlights risk factors such as obesity, type 2 diabetes, and advanced fibrosis—and underscores the growing role of MASH in HCC development, even in the absence of cirrhosis. She outlines best practices for staging, the importance of early referral to hepatology, and AASLD-recommended surveillance protocols using ultrasound and AFP testing every 6 months. The video also explores systemic barriers to screening and actionable strategies to improve adherence, such as EMR alerts, streamlined imaging protocols, and improved coordination between primary care and hepatology. This presentation is essential viewing for healthcare professionals managing patients with liver disease, offering practical tools to enhance HCC detection and optimize long-term outcomes.
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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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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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Podcast: 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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Alcohol and MASLD/MASH: Navigating the Complex Relationship
July 2025
In this insightful episode, Oyin Penny, NP with Premier Gastroenterology of Kansas City, addresses the complex clinical challenge of managing patients with MASLD (metabolic dysfunction-associated steatotic liver disease) who also consume alcohol. Oyin shares practical, evidence-based strategies for screening alcohol use in MASLD and MASH, emphasizing the importance of creating a nonjudgmental, patient-centered environment. She outlines how to use tools like PEth (phosphatidylethanol) testing to objectively quantify alcohol intake and explains the synergistic hepatotoxicity that occurs when alcohol use coexists with metabolic liver disease. Oyin also explores when to initiate non-invasive tests (NITs), why alcohol can distort fibrosis staging, and how to time assessments and treatment appropriately. From setting SMART goals to recommending behavioral support, medications like naltrexone, and exploring mental health and social work interventions, this episode offers a full-spectrum approach to managing high-risk patients. Whether you're a GI, hepatology provider, or in primary care, this episode provides tools for personalized care, alcohol harm reduction, and effective long-term MASLD management.
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Podcast: Discordant NITs, the Gray Zone
June 2025
In this episode, Gabriella McCarty, NP at Northshore Gastroenterology in Cleveland, Ohio, shares her deep clinical insights on the evolving landscape of MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). With over 26 years of experience in private practice, Gabriella explains that the majority of fatty liver cases she encounters are found incidentally—often during evaluations for unrelated GI issues like GERD or routine colon screenings. She discusses the updated nomenclature from NAFLD to MASLD and outlines the cardiometabolic risk factors that inform diagnosis, such as obesity, diabetes, hypertension, and dyslipidemia. Gabriella emphasizes the importance of non-invasive assessments like FibroScan, FIB-4, ELF testing, and, in select cases, liver biopsy or MR elastography for accurate fibrosis staging. She also highlights the challenges of discordant test results and shares practical strategies for follow-up and monitoring. With a strong focus on lifestyle modification—promoting a Mediterranean diet, targeted weight loss, regular exercise, and alcohol avoidance—this episode provides essential education for providers managing patients with fatty liver disease, even when it's not the primary reason for the visit.
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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
July 2025
In this essential FAQ video, Jennifer Geremia, PA-C, a seasoned gastroenterology provider practicing in Boston, outlines current primary care screening guidelines for identifying patients at risk for metabolic dysfunction-associated steatohepatitis (MASH) and MASLD. With nearly two decades of experience caring for GI and liver patients, Jennifer emphasizes the importance of integrating liver health into routine health maintenance—particularly for individuals with type 2 diabetes, obesity, metabolic syndrome, and related conditions. She reviews practical steps for risk stratification, beginning with FIB-4 scoring using readily available labs, and discusses how to interpret and act on the results, including when to refer for further testing like elastography or ELF testing. Viewers will also gain insight into patient counseling strategies, alcohol intake guidance, and the urgency of acting early—even in asymptomatic patients. This video is a must-watch for primary care clinicians aiming to improve detection and management of MASH and MASLD through evidence-based screening and timely intervention.
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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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Podcast: Role of Exercise in Liver Health
June 2025
In this engaging episode of the GHAPP MASLD/MASH Community Network podcast, Jonathan Yeh, PA at Columbia University Medical Center, discusses the essential role of exercise in liver health—especially in managing MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). With over 14 years of hepatology experience, Jonathan breaks down the most effective types of physical activity, highlighting the benefits of combining aerobic and resistance training over high-intensity interval training (HIIT) alone. He provides practical, personalized exercise recommendations tailored to patients’ physical abilities, access to resources, and comorbidities—including suggestions for those with mobility limitations or time constraints. Jonathan also offers motivational strategies to help patients overcome common barriers such as lack of time, motivation, or access to fitness facilities. From parking farther from a destination to lunchtime walks and home-based workouts using resistance bands, he emphasizes creative and realistic ways to build physical activity into daily routines. Beyond weight loss, he explains how exercise directly improves liver function by reducing liver fat, enhancing insulin sensitivity, and preventing fat and sugar buildup in the liver. This episode is a must-watch for clinicians and patients alike seeking to understand and implement exercise as a cornerstone in the management of fatty liver disease.
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