Treatment for Metabolic Associated Steatotic Disease (MASLD)

Introduction to MASLD Treatment

The American Association for the Study of Liver Diseases recommends lifestyle modification, including weight loss of 7-10%, Mediterranean diet, and regular exercise, as the cornerstone of MASLD treatment, with pharmacotherapy reserved for biopsy-proven MASH with significant fibrosis (stage ≥2) 1, 2

The European Association for the Study of the Liver suggests target weight loss of 7-10% in overweight/obese patients with MASLD to improve liver histology, reduce steatosis, inflammation, and reverse MASH 4
The American Heart Association recommends aiming for gradual weight loss of approximately 0.5-1 kg/week to avoid rapid weight reduction which may worsen liver disease 4
The American Diabetes Association strongly recommends a Mediterranean diet, characterized by reduced carbohydrate intake, increased monounsaturated and omega-3 fatty acid intake, and rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil 5
The National Institute of Diabetes and Digestive and Kidney Diseases advises limiting excess fructose consumption, avoiding processed foods with added sugars, replacing saturated fats with polyunsaturated and monounsaturated fats, and avoiding processed foods, fast food, and commercial bakery goods 5
The American College of Sports Medicine recommends both aerobic and resistance training to effectively reduce liver fat in MASLD patients 3

The American Association for the Study of Liver Diseases suggests considering Resmetirom for non-cirrhotic MASH with significant fibrosis (stage ≥2) if locally approved, due to its demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety profile 1, 2, 6
The European Association for the Study of the Liver recommends Vitamin E (800 IU/day) for non-diabetic adults with biopsy-confirmed MASH, improving liver histology through antioxidant properties 5
The American Diabetes Association suggests Pioglitazone (30 mg daily) is effective for patients with biopsy-proven MASH with or without diabetes 3

The American Association for the Study of Liver Diseases recommends considering bariatric surgery as an option for individuals with MASLD and obesity 1, 2, 6
The European Association for the Study of the Liver suggests incretin-based therapies (e.g., semaglutide, tirzepatide) for management of comorbid type 2 diabetes or obesity in diabetic patients with MASLD 1, 2, 6

The American College of Gastroenterology recommends regular follow-up to assess liver function, fibrosis progression, and treatment response 4
The American Heart Association suggests hepatological and cardiovascular follow-up is indicated in all MASLD patients 7
The American Association for the Study of Liver Diseases advises HCC surveillance for patients with MASH-related cirrhosis 4