Melissa Franco
PA-C, MMS
Location : Miami, FL, USA
BIO
Melissa Franco is a Physician Associate at the University of Miami- specializing in the management of patients with liver diseases, ranging from acute hepatitis to complex chronic conditions such as cirrhosis and liver cancer. With a strong focus on MASH, autoimmune hepatitis, PBC, viral hepatitides, and cirrhosis- Melissa is dedicated to delivering compassionate, comprehensive care tailored to each patient's unique needs. She is deeply committed to patient education, and strives to empower individuals to take an active role in their health journey, fostering collaboration, and confidence at every stage of care.
MASLD-MASH Content Featuring Melissa
Common Questions From Patients About MASH
August 2025
Discover practical insights into managing fatty liver disease from Melissa Franco, PA, a hepatology expert at the University of Miami. In this MASLD Community Network episode, Melissa answers one of the most common questions from patients: what causes fatty liver and how to improve it. She explains the multiple factors that can lead to fatty liver, including lifestyle, diet, genetics, alcohol use, and certain medications, and emphasizes the critical role of dietary modifications and regular exercise—often recommending the Mediterranean diet. Melissa also addresses alcohol use in patients with fatty liver, sharing why she discourages it entirely due to its potential to accelerate fibrosis progression, even at mild intake levels. Learn why personalized nutrition, physical activity, and avoiding alcohol are key steps in slowing disease progression and protecting liver health. Whether you’re a patient, caregiver, or healthcare professional, this video offers clear, evidence-based guidance on managing fatty liver disease effectively.
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Non-Invasive Testing With Brian Lam
August 2025
Join Brian Lam, PA-C, Associate Medical Director of Research at Inova’s Liver and Obesity Research Program and Chair of the Global NASH/MASH Council’s PA Committee, for a masterclass on non-invasive testing (NITs) in the evaluation of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH, presented through the GHAPP MASLD/MASH Community Network and sponsored by Madrigal Pharmaceuticals. In this dynamic and case-based session, Brian outlines a practical, step-by-step approach to identifying patients at risk for advanced fibrosis, using tools like FIB-4, ELF, FibroScan (VCTE), and MR Elastography. He walks through the critical cutoffs, diagnostic performance, limitations, and how to interpret imaging and lab-based scores in real-world hepatology and primary care settings. You'll learn how to apply AGA and AASLD clinical algorithms, the importance of staging patients with diabetes and metabolic syndrome, and how to distinguish low-risk MASLD from at-risk MASH. Brian also shares best practices for TE reliability, quality control, and using NIT combinations like FAST, MAST, and MEFIB for accurate diagnosis. With clear visuals, expert insights, and actionable takeaways, this session is an essential update for APPs, GI, hepatology, and primary care providers managing fatty liver disease in 2025 and beyond.
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Comparing F3 and F4 Fibrosis With Erin Tanner
July 2025
Join Erin Tanner, NP from Gastro Health in Birmingham, Alabama, for a practical and in-depth exploration of how to differentiate and manage patients with F3 versus F4 fibrosis in the setting of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH. This session, part of the MASLD & MASH Community Network, features two detailed case studies—Sam A and Sam B—who share identical comorbidities but diverge in fibrosis stage, illustrating how non-invasive testing (NITs) can guide diagnosis and treatment. Erin walks through the clinical application of tools like FIB-4, FibroScan (VCTE), ELF test, and CAP score, emphasizing the importance of interpreting lab and imaging results in context. The discussion covers key decision points, including when to initiate pharmacologic therapy like resmetirom (Rezdiffra), how to determine eligibility for HCC surveillance, and when to consider liver biopsy. She also addresses common challenges in community GI settings, such as incidental fatty liver findings, elevated ferritin levels, and the limitations of FIB-4 in older or diabetic patients. Whether you're in hepatology, gastroenterology, or primary care, this talk offers actionable insights on fibrosis staging, lifestyle counseling, and long-term monitoring in patients with MASLD and MASH.
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Non-Invasive Testing With April Morris
July 2025
In this educational presentation, April Morris, FNP—an experienced provider in both liver disease and endocrinology—guides viewers through the evolving landscape of non-invasive testing (NITs) for diagnosing and managing patients with MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH. Using the case of a 65-year-old male with metabolic co-morbidities and suspected liver disease, Morris reviews how to effectively apply tools like the FIB-4 score, ELF test, and FibroScan (VCTE) to assess fibrosis risk and stratify patients. She compares imaging modalities including transient elastography, MR elastography (MRE), and shear wave elastography, offering practical considerations such as patient eligibility, test accuracy, and insurance barriers. The discussion emphasizes the importance of interpreting NITs within clinical context—highlighting how to determine risk, guide patient counseling, and establish a follow-up plan for low-risk patients. This session also reinforces the role of primary care in longitudinal liver health management and directs providers to resources available through the GHAPP MASLD & MASH Community Network.
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Comparing F3 and F4 Fibrosis With Erin Parkinson
July 2025
In this in-depth clinical discussion, Erin Parkinson, NP from the Tampa General Medical Group Transplant Institute, walks through the nuanced process of differentiating stage 3 and stage 4 fibrosis in patients with MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). Using two illustrative case studies, she explores key clinical signs, lab values, and non-invasive staging tools such as FibroScan, FIB-4, ELF score, and MR elastography. Parkinson discusses the importance of early identification of advanced fibrosis, the reversibility of stage 3 disease, and the implications of a diagnosis of cirrhosis. Erin outlines evidence-based treatment pathways including lifestyle interventions, use of GLP-1 receptor agonists, and initiation of resmetirom (Rezdiffra) for stage 2–3 fibrosis. For cirrhotic patients, the focus shifts to HCC surveillance, screening for clinically significant portal hypertension, and consideration of non-selective beta blockers like carvedilol. This video offers practical insights for hepatology providers navigating the evolving MASLD landscape and highlights how early intervention and accurate staging can impact long-term outcomes.
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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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Lifestyle Management With Erin Parkinson
July 2025
In this impactful session from the GHAPP MASLD Community Network, Erin Parkinson, NP, explores the vital role of lifestyle modifications in the management of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). Through the lens of a real-world case study, Erin illustrates how clinical tools like FIB-4 and FibroScan® can be used to assess fibrosis risk and guide interventions for patients presenting with metabolic syndrome and hepatic steatosis. With a focus on practical, personalized care, this presentation highlights how diet, exercise, and culturally sensitive counseling can meaningfully reduce hepatic fat, inflammation, and fibrosis—key factors in preventing progression to cirrhosis or hepatocellular carcinoma. Erin discusses the impact of processed foods, high-fructose corn syrup, and sedentary behavior, while offering actionable guidance on introducing Mediterranean diets, intermittent fasting, and realistic exercise goals tailored to individual readiness and barriers. Whether you're a hepatology specialist, primary care provider, or obesity medicine clinician, this talk delivers tools to better support patients with MASLD/MASH through sustainable behavioral change and longitudinal follow-up.
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MASLD Basics With Suzanne Robertazzi
July 2025
Join Suzanne, a nurse practitioner from the Washington DC VA Medical Center, as she kicks off a comprehensive lecture series on steatotic liver disease, focusing on the evolving understanding of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). In this foundational session, Suzanne walks through the new nomenclature replacing NAFLD and NASH, and outlines the clinical criteria used to identify and stratify patients along the MASLD–MASH spectrum. Learn how metabolic risk factors such as obesity, prediabetes, hypertension, and dyslipidemia contribute to disease progression, and explore the use of non-invasive diagnostic tools like Fib-4, FibroScan, and ELF scores to assess fibrosis. The session also discusses indications for liver biopsy, the implications of overlapping etiologies (like alcohol-associated liver disease), and strategies for identifying patients at high risk for cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality. This lecture equips clinicians, particularly those in primary care and hepatology, with a practical framework to evaluate steatosis, interpret metabolic profiles, and determine when to refer patients for specialty care. Whether you're new to liver disease or looking for updates on MASLD and MASH terminology, this session is an essential starting point.
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Management of Life Style Modification
January 2025
This video focuses on the comprehensive management of patients with metabolic-associated steatohepatitis (MASH), emphasizing lifestyle modifications, dietary adjustments, and exercise strategies. Key topics include the importance of addressing risk factors like diet, exercise habits, and alcohol intake, as well as referrals to medically supervised weight loss clinics or bariatric surgery for advanced cases. The speaker highlights the benefits of the Mediterranean diet, intermittent fasting, and avoiding ultra-processed foods while discussing the role of resistance training to combat sarcopenia and maintain muscle mass. Practical advice and tailored recommendations ensure a holistic approach to managing MASH and improving patient outcomes.
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Third Step of Life Style Management
January 2025
This video provides a comprehensive overview of emerging pharmacologic treatments for metabolic-associated steatohepatitis (MASH) and their tailored applications based on patient profiles. Topics include FDA-approved therapies, drugs in advanced clinical trials (such as semaglutide and lanifibranor), and the potential for combination treatments targeting both steatohepatitis and fibrosis. The speaker emphasizes the importance of patient-specific approaches considering metabolic profiles, obesity, and diabetes status, alongside lifestyle interventions. Additionally, the video discusses the evolving interdisciplinary care model and highlights the exciting progress in non-invasive testing and treatment advancements for F2-F3 fibrosis.
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Approved Medication for MASH/NASH
January 2025
This video provides detailed guidance on selecting and monitoring patients for emerging therapies targeting advanced fibrosis (F2-F3) in NASH. Key topics include contraindications for patients with cirrhosis, considerations for concomitant medications, and dose adjustments for statins. The video outlines ideal candidates based on specific thresholds for VCTE, MRE, ELF scores, and other non-invasive tests while emphasizing the importance of ruling out portal hypertension and other liver diseases. It also reviews a stepwise monitoring approach, focusing on tolerability at three months and efficacy assessments at six and twelve months, with an emphasis on histologic and non-invasive test improvements.
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Types of Diet for the Treatment of MASLD
January 2025
This video explores comprehensive strategies for managing metabolic-associated steatohepatitis (MASH), focusing on fibrosis risk stratification, lifestyle modifications, and pharmacologic interventions. Learn about dietary recommendations like the Mediterranean diet, exercise guidelines emphasizing resistance training, and the role of intermittent fasting and processed food avoidance. The video also highlights weight loss targets, diabetes management, and emerging therapies such as GLP-1 receptor agonists and bariatric surgery, all aimed at improving liver health and patient outcomes.
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NITs to Identify High Risk MASH Patients
January 2025
Explore advancements in non-invasive diagnostics and risk stratification for liver fibrosis and MASH. This video highlights tools like FIB-4, transient elastography, and innovative scoring systems (e.g., FAST and Agile) to identify and predict outcomes for high-risk patients. Learn about serum biomarkers, updated guidelines, and the role of lifestyle interventions alongside targeted therapies for managing metabolic risks and advancing care in hepatology.
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Discordant NITs: The Gray Zone
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.
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MASLD Basics With Melissa Franco
August 2025
Join Melissa Franco, PA-C, from the University of Miami for a comprehensive review of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and the 2023 nomenclature updates replacing NAFLD and NASH. Presented through the GHAPP MASLD Community Network and sponsored by Madrigal Pharmaceuticals, this session covers the spectrum of steatotic liver disease, including MASLD, MASH, MetALD, alcohol-related liver disease (ALD), and other causes of hepatic steatosis. Learn how to diagnose MASLD using imaging, cardiometabolic risk criteria, and how to exclude other causes like alcohol use, medications, and genetic disorders. Melissa explains how to risk stratify patients using FIB-4, FibroScan, and ELF testing, and when to consider referral to hepatology, especially for patients at intermediate or high risk for advanced fibrosis. The talk also explores global prevalence, natural history, disease progression to cirrhosis and HCC, and highlights the importance of identifying and managing patients with F2–F4 fibrosis, now classified as at-risk MASH. Through a real-world case study, viewers are guided on how to perform a thorough MASLD workup and assess patients for pharmacotherapy, lifestyle counseling, and surveillance protocols. Whether you are in primary care, GI, or endocrinology, this session is an essential resource for early diagnosis and comprehensive management of fatty liver disease in today’s clinical practice.
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Comparing F3 and F4 Fibrosis With Maribeth Capuno
August 2025
Join Maribeth Capuno, DNP, from the Richmond VA Medical Center, for an insightful case-based discussion on F3 vs. F4 fibrosis staging in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH, presented through the GHAPP MASLD/MASH Community Network and sponsored by Madrigal Pharmaceuticals. Using the fictional case of “Sam,” Maribeth demonstrates how to differentiate between F3 and F4 fibrosis using non-invasive tools like FIB-4, FibroScan, and the ELF test, while explaining their respective cutoffs and clinical implications. Learn how to stage MASLD accurately, when to consider MRI elastography or liver biopsy, and how to initiate evidence-based management strategies including lifestyle modification, GLP-1 therapy, and the newly approved medication Resmetirom (Rezdiffra). The session highlights the importance of HCC surveillance, portal hypertension screening, and the nuances in monitoring between F3 and F4 fibrosis stages. With a strong emphasis on practical, guideline-aligned hepatology care, this video provides essential insights for clinicians managing the growing MASLD population.
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FAQ's
Common Questions From Patients About MASH
August 2025
Discover practical insights into managing fatty liver disease from Melissa Franco, PA, a hepatology expert at the University of Miami. In this MASLD Community Network episode, Melissa answers one of the most common questions from patients: what causes fatty liver and how to improve it. She explains the multiple factors that can lead to fatty liver, including lifestyle, diet, genetics, alcohol use, and certain medications, and emphasizes the critical role of dietary modifications and regular exercise—often recommending the Mediterranean diet. Melissa also addresses alcohol use in patients with fatty liver, sharing why she discourages it entirely due to its potential to accelerate fibrosis progression, even at mild intake levels. Learn why personalized nutrition, physical activity, and avoiding alcohol are key steps in slowing disease progression and protecting liver health. Whether you’re a patient, caregiver, or healthcare professional, this video offers clear, evidence-based guidance on managing fatty liver disease effectively.
Watch Now
