Updated European MASLD Guidelines Review Prevention, Screening, and Treatments

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. MASLD prevalence in the US is approximately 34%, but in specific populations, such as those with obesity, it can be as high as 75%.¹ A review published in eGastroenterology highlights key takeaways from the 2024 European Guidelines for the Diagnosis, Treatment, and Management of MASLD.²

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A multi-society consensus in 2023 introduced the terms MASLD and metabolic dysfunction-associated steatohepatitis (MASH) to replace non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.³ MASLD and MASH are both forms of steatotic liver disease (SLD). MASH is the progressive form of the disease, whereas MASLD is SLD with 1 or more cardiometabolic risk factors.²

Cardiometabolic conditions, especially obesity and type 2 diabetes (T2D), are the most prominent risk factors. These conditions are associated with increased fat deposits, oxidative stress, and lipotoxicity, ultimately leading to inflammation.² MASLD screening should be conducted in high-risk populations: those with T2D, abdominal obesity and at least 1 additional cardiometabolic risk factor, or those with repeatedly abnormal liver enzymes.² Patients with MASLD are also at increased risk for many comorbidities and should be routinely monitored for T2D, dyslipidemia, hypertension, chronic kidney disease, and extrahepatic cancers.²

The mainstays of MASLD prevention and non-pharmacological treatment are as follows²:

• An active lifestyle with at least 150 minutes per week of moderate activity or 75 minutes per week of intensive activity has potential positive effects on MASLD regardless of weight reduction.
• Patients should avoid alcohol, nicotine, and highly processed or sugar-sweetened products.
• A Mediterranean diet that emphasizes vegetables, fruits, nuts and seeds, fish, seafood, and olive oil.

Weight reduction is recommended due to the prominent risk factors of obesity and insulin resistance in MASLD. In overweight or obese patients, 5% to 10% or greater weight loss leads to reduced liver fat, inflammatory activity, and liver fibrosis. In normal-weight patients, a 3% to 5% reduction can lead to MASLD remission.²

Bariatric surgery is recommended for consideration in eligible patients with non-cirrhotic MASLD. In addition to the permanent weight reduction, potential benefits include steatohepatitis resolution, fibrosis improvement, and reduction in cardiovascular events.²

Proper management of comorbid cardiometabolic conditions such as diabetes and dyslipidemia is essential for disease management. Glucagon-like peptide-1 (GLP-1) receptor agonists and co-agonists, sodium glucose transporter 2 inhibitors (SGLT2i), metformin, and statins should be prioritized when indicated. These drug classes have shown reductions in cardiovascular morbidity and mortality and have positive benefits in MASH.²

Resmetirom (Rezdiffra; Madrigal), a thyroid hormone receptor β-agonist, is currently the only FDA-approved MASH-specific treatment available. However, positive data with GLP-1 agonists and co-agonist trials promise more options in the near future.²

MASLD is a complex disease affecting almost one-third of the US population. Its prevalence is expected to continue rising, correlating with increases in obesity and diabetes. This projected stress on the health care system underlines the importance of prevention and early detection. The recent approval of the first specific drug (with others expected to follow) marks significant advancement in MASLD treatment. Pharmacologic therapies are just 1 component, however. Patients should be supported by a multidisciplinary team, frequent evaluations, and behavioral therapy for optimal care.²

REFERENCES

1. Manikat R, Ahmed A, Kim D. Current epidemiology of chronic liver disease. Gastroenterol Rep (Oxf). 2024;12:goae069. doi:10.1093/gastro/goae069

2. Horn P, Tacke F. Key takeaways from the updated multidisciplinary European MASLD guidelines. eGastroenterology. 2025;3(2):e100196. doi:10.1136/egastro-2025-100196

3. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556. doi:10.1016/j.jhep.2023.06.003