MASLD Risk Factors Every Pharmacist Should Screen

In an interview with Pharmacy Times, Susan Cornell, PharmD, CDE, FAPhA, FAADE, associate director of experiential education and an associate professor of pharmacy practice at Midwestern University Chicago College of Pharmacy, discussed insights from her presentation at the 2026 Association of Diabetes Care and Education Specialists Annual Meeting in Columbus, Ohio. The presentation, titled “Optimizing MASLD Treatment: The Power of Medications Plus Lifestyle Strategies,” highlighted how pharmacists can identify metabolic dysfunction–associated steatotic liver disease (MASLD) and weigh the medications used to treat it.

Cornell explained that MASLD—fat accumulating in the liver—is often silent, and that the clinical goal is both to reduce liver fat and to prevent the inflammation and fibrosis that progress to metabolic dysfunction–associated steatohepatitis (MASH). Because fat drives inflammation, she noted that obesity, particularly central adiposity, is a central concern and that hepatocytes filled with fat can eventually balloon and burst, setting the stage for fibrosis.

She outlined the risk factors that should prompt a pharmacist to act: obesity, prediabetes or type 2 diabetes, high blood pressure, and dyslipidemia such as high triglycerides or low high-density lipoprotein. Cornell pointed to the FIB-4 index, which incorporates aspartate aminotransferase, alanine aminotransferase, platelets, and age, as a fast, accessible screening tool a pharmacist can calculate on a phone, emphasizing that earlier diagnosis gives patients a better chance to reverse liver fat before damage occurs.

On pharmacotherapy, Cornell identified high-dose semaglutide (Wegovy HD; Novo Nordisk) and resmetirom (Rezdiffral; Madrigal Pharmaceuticals) as the 2 options currently approved for MASH with F2 or F3 fibrosis. She described semaglutide as a medication pharmacists can "double-dip" with, delivering glucose lowering, weight loss, and cardiovascular, kidney, and liver protection. She characterized pioglitazone (Actos; Takeda Pharmaceuticals) as an off-label "exercise in a pill" that improves liver fat, while cautioning that sodium-glucose cotransporter 2 (SGLT2) inhibitors remain unproven for MASLD, with clinical trials ongoing. Throughout, Cornell reinforced that reducing weight, exercising, and eating healthy foods remain the foundation for addressing liver fat, with medications layered on top rather than substituted for lifestyle change. For pharmacists, the takeaway is a clear, evidence-based framework for screening and drug selection.