Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Diagnosis and Management

Key Definitions and Diagnostic Criteria

• The current preferred terminology, MASLD, is defined as the presence of hepatic steatosis plus at least one cardiometabolic risk factor, according to the American Association for the Study of Liver Diseases 1, 2, 3
• The European Association for the Study of the Liver defines NAFLD as the presence of hepatic steatosis in the absence of significant alcohol consumption, with a spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) and fibrosis/cirrhosis 4, 5, 6
• The American Diabetes Association notes that MAFLD is a transitional term that has been superseded by MASLD, with similar diagnostic criteria focusing on metabolic etiology 7, 1, 2, 3

Diagnostic Framework and Classification

• The American College of Gastroenterology categorizes steatotic liver disease (SLD) into MASLD, MetALD, and ALD, based on the presence of hepatic steatosis, cardiometabolic risk factors, and alcohol intake 1, 3
• The European Association for the Study of the Liver identifies type 2 diabetes, obesity, and metabolic dysregulation as cardiometabolic risk factors for MASLD diagnosis 3, 8, 9

Clinical Implications and Population Overlap

• The American Association for the Study of Liver Diseases reports a nearly complete overlap between NAFLD and MASLD populations, with 99.8% accordance in tertiary NAFLD cohorts 1
• The National Institute of Diabetes and Digestive and Kidney Diseases notes that only 5.3% of individuals with NAFLD did not fulfill MASLD criteria, based on the NHANESIII database 1

Practical Approach to Diagnosis

• The American Gastroenterological Association recommends a diagnostic algorithm involving identification of hepatic steatosis, assessment of cardiometabolic risk factors, evaluation of alcohol consumption patterns, and ruling out other specific etiologies of steatosis 1, 2, 3, 8
• The European Association for the Study of the Liver advises against common pitfalls, including failing to assess alcohol consumption quantitatively and qualitatively, and not considering the overlap between metabolic risk and alcohol consumption (MetALD) 1, 2, 5

Clinical Management Implications

• The American Diabetes Association states that evidence generated under the NAFLD definition can be fully extrapolated to individuals with MASLD, with management focusing on lifestyle modification, weight loss, and addressing metabolic comorbidities 1, 8, 9
• The American Association for the Study of Liver Diseases notes that new pharmacological treatments, such as resmetirom, are being evaluated specifically for MASH with significant fibrosis, and screening strategies should target high-risk populations with cardiometabolic risk factors 3, 8, 9