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MASLD AI 08:24 PM
September 2025
Maly Tiev, NP, NYU Langone Health, shares a practical, case-based walkthrough of non-invasive testing (NITs) for MASLD/MASH—showing how to move from initial risk identification to confident staging and follow-up without a biopsy in most patients. Using Albert’s case, a 65-year-old with steatosis and mild ALT elevation, she explains how to apply FIB-4 first, then layer in FibroScan/VCTE with Liver Stiffness (kPa) and CAP for fat quantification, plus when to order ELF or MRI elastography. You’ll learn reliability checks for FibroScan, common confounders, insurance/operational tips for MRE, and an easy algorithm for primary care/endocrine clinics: start with FIB-4 → triage by cutoffs → use VCTE/ELF → refer when intermediate or high risk. She closes with clear next steps for low-risk patients—lifestyle modification, cardiometabolic optimization, and repeating NITs in 2–3 years—and when to escalate to hepatology for advanced disease.
Related Podcast
Common Questions from Primary Care Providers About MASH
July 2025
In this informative episode, Emily Przybyl, PA-C at Erie County Medical Center in Buffalo, NY, answers two of the most common questions primary care providers have about MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis): When should I refer to hepatology? and Is it safe to prescribe statins in patients with fatty liver disease? Emily explains that any history of hepatic steatosis on imaging or elevated liver enzymes (LFTs) is reason enough to initiate referral for further workup, including non-invasive testing like FIB-4 or FibroScan®. She also debunks the common myth that statins should be avoided in this population, emphasizing that statins are not contraindicated and are critical for managing cardiometabolic risk factors that drive liver disease progression. This episode is a must-watch for clinicians navigating MASLD/MASH in primary care, with practical guidance that supports early intervention and evidence-based management.
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Beyond Basic NITs: When is Liver Biopsy or Advanced Imaging
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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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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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In this insightful video, Jordan Mayberry, a seasoned physician assistant at UT Southwestern in Dallas, explores the complex intersection of alcohol use and metabolic-associated steatotic liver disease (MASLD), including its progressive form, MASH. With over 12 years of hepatology experience, Jordan breaks down why accurate assessment of alcohol intake is essential—not just for diagnosis but for guiding patient management. Learn how to use motivational interviewing techniques to respectfully screen for alcohol use, quantify intake effectively, and differentiate between MASLD, MASH, and the emerging diagnosis of MetALD (metabolic dysfunction-associated alcoholic liver disease). Jordan also shares practical tips on managing patients with MASH who drink above recommended thresholds, including behavioral interventions, medications like acamprosate, and referral pathways such as SMART Recovery or addiction psychiatry. The video also highlights how ongoing alcohol use can skew liver function tests (LFTs), distort non-invasive testing (NIT) results like FibroScan or MRE, and potentially affect eligibility for future MASH pharmacotherapies. This session is a must-watch for clinicians aiming to provide holistic, evidence-based care to patients navigating the dual challenges of liver disease and alcohol use.
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Comparing F3 and F4 Fibrosis With Michelle Barnett
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In this installment of the GHAPP MASLD Community Network, Michelle Barnett, PA-C from Peak Gastroenterology in Colorado Springs, presents a deep dive into the clinical management of MASH—formerly known as NASH or non-alcoholic steatohepatitis. Through two comparative case studies, Michelle explores the nuances of diagnosing and managing patients with F3 and F4 fibrosis. Learn how to effectively use non-invasive diagnostic tools like FIB-4, FibroScan, and ELF testing, and gain valuable insights into stratifying fibrosis risk, monitoring hepatocellular carcinoma (HCC), and determining when resmetirom is appropriate. This session also covers practical guidance on nutrition, exercise, medication safety, and multidisciplinary care for patients with advanced liver disease. Whether you're a hepatology specialist or a primary care provider navigating the MASLD/MASH landscape, this video offers actionable strategies to improve long-term patient outcomes and reinforces the critical role of lifestyle intervention and liver disease surveillance.
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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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Join Brian Lam, PA-C, Associate Medical Director of Research at INOVA and Chair of the Global NASH/MASH Council, for an insightful discussion on pharmacotherapy for MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease), also known as fatty liver disease. This episode, part of the GHAPP MASLD Community Network, explores the evolution of treatment options—including GLP-1 receptor agonists like semaglutide and tirzepatide, the antioxidant benefits of vitamin E, the metabolic impact of pioglitazone, and the targeted liver-specific mechanism of action of Resmetirom (a THR-β agonist). Learn how weight loss remains a foundational strategy for MASH management, but with FDA approval of new agents like Resmetirom in March 2024, we now have more tools to address hepatic inflammation and fibrosis directly. Brian also shares practical considerations around comorbidities, cardiovascular risk, statin use, and how to evaluate appropriate patients using non-invasive testing like transient elastography and MR elastography. Whether you're new to managing fatty liver or an experienced hepatology APP, this overview provides the latest guidance and clinical insight to improve patient outcomes in MASLD and MASH care.
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