Navigating the Maze: A Mini-Guide for the Management and Therapy of Metabolic Dysfunction-associated Steatotic Liver Disease

Authors

  • Giada Sebastiani, MD Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
  • Felice Cinque, MD Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada SC-Medicina Indirizzo Metabolico, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Department of Pathophysiology and Transplantation, University of Milan, Italy

DOI:

https://doi.org/10.58931/cpct.2024.2232

Abstract

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Nonalcoholic Fatty Liver Disease (NAFLD), poses a significant global health challenge with a prevalence of 30% worldwide. Alarming projections anticipate a substantial increase in MASLD cases, highlighting the urgent need for preparedness and effective policies. The pathophysiology of MASLD involves a complex interplay of metabolic, genetic and lifestyle factors. Although liver biopsy remains the gold standard for the diagnosis of MASLD, non-invasive methods such as abdominal ultrasound, transient elastography with controlled attenuation parameter, shear wave elastography, and non-invasive serum fibrosis scores have been developed and validated. Effective risk stratification in primary care with non-invasive fibrosis scores, such as fibrosis 4 (FIB-4) index and NAFLD fibrosis score (NFS), optimizes healthcare resource utilization, ensuring appropriate referrals for high-risk patients while minimizing unnecessary referrals. Lifestyle intervention, including diet and physical activity, remains the primary therapy for MASLD. Notably, with the FDA approval of resmetirom, the first authorized medication for fibrotic metabolic dysfunction-associated steatohepatitis (MASH), and several antifibrotic agents under investigation, the therapeutic landscape for MASLD is rapidly evolving. Despite its increasing prevalence, morbidity and mortality, MASLD is frequently underdiagnosed in primary care. In this review, we aim to provide primary care physicians an update on the diagnosis, management and treatment
of MASLD.

Author Biographies

Giada Sebastiani, MD, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada

Giada Sebastiani is Professor of Medicine in the Division of Gastroenterology and Hepatology at McGill University. She received a medical degree and specialized in internal medicine at the University of Padua, Italy. She had research training at Harvard Medical School (US), University College of London (UK), University of Bordeaux (France). Her work focuses on steatotic liver disease (MASLD), liver fibrosis and non-invasive diagnostic tools in liver disease. She is author of 170 articles in peer-reviewed journals (including Nature Reviews Gastroenterology & Hepatology, Lancet Gastroenterology and Hepatology, Lancet Digital Health, Gastroenterology, Hepatology, Journal of Hepatology, Clinical Infectious Diseases; h-index=46, citations>9,500), 13 book chapters, 275 conference publications. Dr Sebastiani is the 2024 President Elect of the Canadian Association for the Study of the Liver. She is co-founder of the Canadian NASH Network and panel member in the Consensus on Models of Care in MASLD of the International Liver Foundation. She is the sole North American representative in the guidelines of the European AIDS Clinical Society as panel member of the Liver Group. Dr Sebastiani was awarded the prestigious Senior Clinical Research Salary Award from Fonds Recherche Sante Quebec. Her research program is funded by the Canadian Institute for Health Research, the Fonds Recherche Sante Quebec, the CIHR Canadian HIV Trials Network, Crohn’s Colitis Canada.

Felice Cinque, MD, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada SC-Medicina Indirizzo Metabolico, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Department of Pathophysiology and Transplantation, University of Milan, Italy

Dr. Felice Cinque is a clinician-scientist currently enrolled in the last year of internal medicine residency and the first year of the PhD program in clinical research at the University of Milan. He completed a research fellowship at McGill University in the Division of Gastroenterology and Hepatology and Infectious Diseases in 2023. His work focuses on chronic liver disease, MASLD in vulnerable populations such as people living with HIV and people with diabetes, with a focus on patient-centered care. He is also an advocate for the inclusion of the LGBTQ+ community in medicine and research.

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Published

2024-09-09

How to Cite

1.
Sebastiani G, Cinque F. Navigating the Maze: A Mini-Guide for the Management and Therapy of Metabolic Dysfunction-associated Steatotic Liver Disease. Can Prim Care Today [Internet]. 2024 Sep. 9 [cited 2024 Oct. 8];2(2):34–40. Available from: https://canadianprimarycaretoday.com/article/view/2-2-sebastiani-et_al

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